services connect: review of the client support model lead ... · acil allen consulting iii list of...

A C I L A L L E N C O N S U L T I N G

REPORT TO

DEPARTMENT OF HUMAN SERVICES

5 AUGUST 2014

SERVICES CONNECT

REVIEW OF THE CLIENT SUPPORT MODEL LEAD SITE TRIAL

PROJECT REPORT

ACIL ALLEN CONSULTING PTY LTD

ABN 68 102 652 148

LEVEL FIFTEEN

127 CREEK STREET

BRISBANE QLD 4000

AUSTRALIA

T+61 7 3009 8700

F+61 7 3009 8799

LEVEL TWO

33 AINSLIE PLACE

CANBERRA ACT 2600

AUSTRALIA

T+61 2 6103 8200

F+61 2 6103 8233

LEVEL NINE

60 COLLINS STREET

MELBOURNE VIC 3000

AUSTRALIA

T+61 3 8650 6000

F+61 3 9654 6363

LEVEL ONE

50 PITT STREET

SYDNEY NSW 2000

AUSTRALIA

T+61 2 8272 5100

F+61 2 9247 2455

SUITE C2 CENTA BUILDING

118 RAILWAY STREET

WEST PERTH WA 6005

AUSTRALIA

T+61 8 9449 9600

F+61 8 9322 3955

ACILALLEN.COM.AU

SUGGESTED CITATION FOR THIS

REPORT

ACIL ALLEN CONSULTING 2014,

SERVICES CONNECT: REVIEW OF

THE CLIENT SUPPORT MODEL

REVIEW FINAL REPORT


ii

C o n t e n t s Executive summary v

1 Context 1

1.1 Services Connect 1

1.2 Testing of Client Support in the lead sites 2

1.3 Project method 3

1.4 This report 5

2 Enabling changes 6

2.1 Appropriate clients identified and transitioned 6

2.2 Appropriate staff and training in place 16

2.3 Key workers provided with sufficient information 23

2.4 Outcomes-based client driven planning introduced 26

3 Project outcomes 31

3.1 Allocation of a single key worker and integrated service plan 31

3.2 Holistic support based on comprehensive assessment of

need 35

3.3 Service response levels reflect level of need 37

3.4 Services planned and delivered to achieve client outcomes 39

4 Intermediate benefits 44

4.1 More effectively targeted services 44

4.2 Reduced repeat service usage 46

4.3 Reduced service intensity over time 47

4.4 Reduced number of workers 49

5 Barriers to be resolved 51

5.1 Design barriers 51

5.2 Barriers arising from introducing service change 54

Appendix A Evaluation framework A-1

Appendix B Data strategy, sources and definitions B-1

Appendix C Stakeholder engagement C-1


iii

List of figures

Figure 1 The Services Connect service delivery model 1

Figure 2 Trial timeline April 2012 to April 2014 2

Figure 3 Services Connect Client Support Model benefits map and project scope for this review 4

Figure 4 Cumulative cases opened and closed, by support level 7

Figure 5 Number of DHS programsa experienced by clients: in the 12 months prior to commencement in Client Support; and for all recorded history 8

Figure 6 Number of clients by main established program areaa involvement: in the 12 months prior to commencement in Client Support; and for all recorded history 9

Figure 7 Number of program events by total duration of involvement with DHS programa area 9

Figure 8 Statutory orders for Guided and Managed Support cases after first completed Outcomes Star 10

Figure 9 Statutory orders and number of DHS services at time of referral for the case file audit 14

Figure 10 Length of client involvement in DHS services prior to referral 15

Figure 11 Extent to which Client Support staff agree they receive adequate information at the time of referral of clients, to support their transition into Client Support 15

Figure 12 Proportion of agreed FTE Client Support staff in place – all sites 19

Figure 13 Extent to which Client Support staff agree they now have the skills needed to deliver all of the key components of the Client Support Model. 20

Figure 14 Extent to which Client Support staff agree that induction training (or bridging programs), and subsequent learning and development opportunities provided them with the skills they needed to deliver Client Support 21

Figure 15 Extent to which Client Support staff agree they have a good understanding of the statutory requirements of their clients 22

Figure 16 Extent to which Client Support staff agree they receive the practice guidance and support they need to successfully deliver the Client Support service 23

Figure 17 Extent to which Client Support staff agree they access and share client information when they need it. 25

Figure 18 Extent to which established program areas agree that Client Support and established program area staff access and share client information when needed 25

Figure 19 Extent to which Client Support staff agree they have sufficient knowledge about their local human services system to develop holistic plans with their clients 26

Figure 20 Proportion of case transitions between Managed and Guided Support 27

Figure 21 Extent to which Client Support staff agree they have a comprehensive understanding of their clients’ needs 28

Figure 22 Extent to which Client Support staff agree their clients are experiencing client driven planning 29

Figure 23 Extent to which Client Support staff agree they have the tools to enable outcomes based, client driven planning 29

Figure 24 Extent to which Client Support staff agree they feel supported and prepared for client driven planning 30

Figure 25 Extent to which Client Support staff agree they have now become the main point of contact between their clients and the broader human services system 31


iv

Figure 26 Extent to which the Client Support workforce report that clients have a single case plan that enables coordination of the full range of support and services their clients need 34

Figure 27 Average number of needs identified at completion of first star, by reason for referral and level of need 36

Figure 28 Referral patterns post CNI and / or initial engagement 36

Figure 29 Services provided align with the Client Support client plan 37

Figure 30 Extent to which outcomes focussed planning results in the ceasing of existing services or referral requests 37

Figure 31 Proportion of active cases allocated to Managed / Guided Support levels 38

Figure 32 Outcomes Star agreement 40

Figure 33 Progress on the Star: Proportion of clients with a change in score against star outcomes 40

Figure 34 Median active case duration for Guided and Managed Support cases, across all five lead trial sites 44

Figure 35 Average closed case duration 45

Figure 36 Extent to which Client Support staff, and representatives from established program areas consider that clients are experiencing more targeted support 46

Figure 37 Proportion of Services Connect clients who re-present to a selected programa within cumulative 6-monthly intervals 47

Figure 38 Change in the number of services accessed by intensitya between completion of first star and exit 48

Figure 39 Proportion of services connect casesa that had a reported decrease in the number of emergency / crisis and servicesb from completion of first star to exit 50

Figure 40 Number of services accessed at completion of first star and at exit from client support, by specialist service category 50

List of tables

Table 1 Overview of review activities 5

Table 2 Number of clients per case 7

Table 3 Time elapsed between referral / allocation / first contact 16

Table 4 Key Worker role and activity in care teams 33

Table A1 Measuring the extent to which enabling changes have been introduced, as originally designed A-2

Table A2 Measuring the extent to which project outcomes are being achieved A-3

Table A3 Measuring the extent to which intermediate benefits have been realised A-4

Table B1 Administrative data sources B-1

Table B2 Services Connect Progress Dataset - data quality statement B-2

Table B3 Service Categorisation – Progress Dataset B-4

Table B4 Key measure definitions B-8

Table B5 Services Connect case and sample numbers by site B-9

Table B6 Case review template B-11

Table C1 Engagement with the lead sites C-1


SERVICES CONNECT: REVIEW OF THE CLIENT SUPPORT MODEL LEAD SITE TRIAL

v

Executive summary

In April 2014, DHS commissioned ACIL Allen Consulting to review the testing of the

Services Connect Client Support Model (the Client Support Model) across five lead sites, to

assess the extent to which the model was operating as intended. The review was conducted

between April and August, 2014.

The introduction of the Client Support Model represents a significant change in structure,

professional practice and organisational culture for DHS, and a significant change in

arrangements for clients. As with most significant change initiatives, embedding such a

major change to practice and culture should be expected to take time. As expected, it is

taking time to realise the anticipated benefits associated with the Client Support Model.

Building the Client Support Model in the three initial sites (Dandenong, Geelong and

Warrnambool) allowed for testing, and further refinement and development of the Model.

This approach enabled adaption of the Model to local need or circumstance. It also meant

that introduction of the Model was, at times, ad hoc, with adjustments made as required.

The review identified evidence that the foundations have been laid to realise the reform’s

objectives across the lead sites.

Findings: what is working well

The review found that across the five sites many of the enabling changes were largely in

place, and local operation of the model was increasingly embedded in practice. These

findings are outlined below.

Client Support workforce

On balance, the review found that the Client Support staff had the skills, guidance and

confidence to deliver outcomes based client driven services. Critical to this was the

composition of teams, with members drawn from different established program areas,

and the level of professional support made available to the Client Support team.

A substantial learning and development program supported Client Support staff over the

course of testing the Client Support Model. The majority of staff participated in training

on fundamental components of the Model, such as Motivational Interviewing and the

Outcomes Star. Local learning and development activities were put in place, with the

Practice Consultant role central to these local training and development activities.

Client Support service planning, delivery and use

Most Client Support staff agreed that they received adequate client information from

programs to support their clients’ transition into Client Support at the time of referral.

Despite the need to navigate multiple client IT databases, Client Support teams and

established program area staff are finding ways to share and access required client

information.

At the client level, service planning and coordination occurred principally through care

team meetings, which were established based on client need and complexity, and there

was evidence that Client Support was providing more targeted and coordinated service

delivery. While trialling of the Model was ongoing and in two sites was less than one

year old, and quality and availability of program wide data remained problematic, there



vi

were indications that Client Support was beginning to lead to a reduced use of support /

case management, and emergency and crisis type services.

The review found evidence that just over half the clients in closed Client Support cases

experienced some reduction in the use of intense services (categorised as either

emergency / crisis or support services), and that a smaller proportion had increased their

access of less-intense more preventative services (based on DHS data).

There appeared to be a reduction in the number of workers involved with Client Support

cases over time.

Findings: what is working less well

The review identified a number of barriers that, if addressed, would improve the realisation

of anticipated outcomes and benefits associated with the Client Support Model. The most

pressing of these barriers are outlined below.

Limitations of Model testing

There is a lack of clarity regarding how clients with statutory orders that extend beyond

the four and six month durations of Guided and Managed Support are to be

accommodated in the Client Support Model.

It is difficult to properly test the appropriateness of the tiered support levels prior to

expanding intake further into established program areas and the community sector, to

enable referrals from a wider client pool.

Variable use of some Client Support tools

There was inconsistent use of some Client Support tools across the lead sites. The

review found that the CNI tool was not valued by all staff and that participation in training

on the use of the CNI tool was significantly lower than for other tools.

The use of Client Support Case Plans did not accord with the client-driven and

outcomes-based objectives of the Model. Its current use did not support accountability,

transparency and client ownership.

Care team meetings did not appear to be embedded in case practice to the extent that

may have been expected (noting that they are not a mandated feature of case practice).

Client information and knowledge of wider human services system

Variability in the quality and consistency of client information continued to pose problems

for Client Support staff when clients transitioned into Client Support.

Many staff acknowledged that their knowledge of the wider human services sector was

inadequate at commencement in the role, though this did improve markedly over time.

Looking ahead

Trialling to date has allowed DHS to test and further develop key elements of the Services

Connect Client Support Model.

Evidence collected during the course of this review indicated the foundations of the Model –

principally staff and practice – were largely in place across the five lead sites, and that there

were early signs of more targeted and coordinated service delivery and use being achieved

by Client Support.

This period of early testing has identified some fundamental design barriers that need to be

addressed for the Model’s successful development and expansion across the wider human

services sector.



1

1 Context

The Department of Human Services (DHS) is currently testing the Services Connect Client

Support Model across five lead sites. Client Support is one component of the broader

Services Connect Model.

DHS commissioned ACIL Allen Consulting to review the testing of the Services Connect

Client Support Model (the Client Support Model) across the five lead sites, to assess the

extent to which this part of Services Connect was operating as intended. The review was

conducted between April and August, 2014. The findings of the review will inform any further

development or potential expansion of the Client Support Model.

1.1 Services Connect

Services Connect is intended to be much more than a new approach to case management.

It is designed to improve how government and non-government service providers work

together and how people access and use services, including:

How people access information and services

How a person’s range of needs are identified

How support and services for people are planned

How services are delivered to improve people’s lives.

As illustrated in Figure 1 below, Services Connect spans the stages of Access, Identify, Plan

and Service Response. Achieving improvements across each of these stages will require

changes over time in information and communication technologies, workforce development,

and culture and leadership change. Significant transformative change is required at each of

these four stages to fully realise the objectives of the Services Connect model.

Figure 1 The Services Connect service delivery model

Source: Victorian Government, Services Connect, Better services for Victorians in need, 2013



2

Recognising that people engaging with the human services system have different needs,

the other key design feature is the tiering of support. The three Services Connect tiers

comprise:

Managed support – for people with the most complex situations, who require multiple

services and more intensive coordination and assistance

Guided support – for people with moderate to high needs, who require some

coordination and occasional assistance

Self Support – for people who largely self manage their support and services with

minimal assistance.

1.2 Testing of Client Support in the lead sites

DHS is testing key elements of Services Connect, specifically the Client Support Model,

which has been trialled in five lead sites across the state. While future expansion of the

Client Support Model has been announced as part of the 2014-15 Victorian Government

State Budget, the focus of the review – and of this report – is on activity to date in the five

lead sites.

Managed Support was first introduced across three select lead sites in 2012:

Geelong, Barwon Area

Dandenong, Southern Melbourne Area

Warrnambool, South-West Coast, Western District Area

In 2013 a further two lead sites were established:

Shepparton, Goulburn Area

Preston, North-East Melbourne Area

Figure 2 provides an overview of the trial timeline of Client Support in each of the five lead

sites. It also charts the introduction of key elements and tools of the model over time.

Figure 2 Trial timeline April 2012 to April 2014

Source: Program documentation; consultation data; and CRISSP Case Allocations Report, total cases period ending April 2014



3

It is important to note that the Client Support Model represents a significant change in

structure, professional practice and organisational culture for DHS, moving from what has

traditionally been a process driven environment to more of a strengths based and outcomes

focussed way of working.

This represents a considerable challenge to the Client Support staff and to those continuing

in the established program areas. As with most significant change initiatives, embedding a

major change to practice should be expected to take time.

In addition, testing of Client Support has occurred within an environment of major change

across DHS. Policy reforms across a range of areas and implementation of the DHS

organisational restructure have been contextual experiences concurrent with the testing of

Client Support in the lead sites.

The testing of the model in situ is the other factor that should be considered when

interpreting the review findings. Live testing and subsequent building of the Model based on

emerging practice, evidence and operational learnings has been a deliberate design

approach to the testing of the Client Support Model.

This approach maintained the momentum for reform with the human service delivery sector.

It enabled and fostered local innovation and adaptation of the Model within trial sites.

However, it also meant the Model and how it was experienced by Client Support Staff,

clients, and other DHS workers, changed significantly over the course of the trial. It was

evident from engagement with each of the lead sites that this experience of change proved

unsettling for many, and that practice and attitudes to the Model based on early experience

sometimes proved difficult to shift.

1.3 Project method

The purpose of this review was to conduct a review of the trialling of the Services Connect

Client Support Model across five lead sites to assess the extent to which the model was

operating as intended.

Consequently, the focus of this review was on the change and impacts experienced by DHS

as a result of trialling the Client Support Model. The review was premised on the program

theory underpinning the Client Support Model being sound, and focussed on the process,

cultural and organisational elements that were necessary to bring about longer term goals of

the broader Services Connect reform.

Client Support Model Benefits Map

The Services Connect Client Support Model Benefits Map tracks the logic and relationships

from introduction of the Model, including the enabling changes required to achieve specified

outcomes, to realisation of anticipated benefits, through to longer term outcomes and

objectives.

Figure 3 outlines the Services Connect Client Support Model benefits map in its entirety and

highlights the particular scope and focus of this review.


SERVICES CONNECT REVIEW OF THE CLIENT SUPPORT MODEL LEAD SITE TRIAL

4

Figure 3 Services Connect Client Support Model benefits map and project scope for this review

Source: DHS, Services Connect Client Support Model benefits map



5

Given that the Client Support Model remains in a testing phase, and recognising the process

focus of this review, the program logic underpinning the benefits map was accepted as the

foundation for this review.

Accordingly the review focused on measuring the extent to which:

Enabling changes were established within the lead sites

Specified project outcomes were being achieved

Anticipated intermediate benefits were being realised

Accordingly the project’s key review questions comprise:

Have Client Support Model enabling changes been successfully introduced to achieve

project outcomes?

Is the Client Support model realising anticipated intermediate benefits?

What barriers must be resolved for successful Client Support Model introduction and

benefits realisation?

Key review data collection activities are summarised in Table 1 below.

Table 1 Overview of review activities

Data collection activity Description

Data analysis

The sources of data analysed for the review included:

Services Connect database (CRISSP)

Services Connect Progress dataset

Common Client Index

Review of Services Connect case file sample

Lead site interviews

Client Support Model Structured Questionnaire data

DHS Client Support Model HR dataset

Lead site consultations

In each of the five lead sites semi-structured interviews were held with:

Area-Directors

IFS Managers

Service Connect project coordinators

Practice Consultants

DHS established program area staff (Child Protection, Youth Justice, Disability, Housing and Refugee Minor Program)

A structured questionnaire was completed with 45 Client Support team leaders and key workers across all sites.

Case file review Sample of 42 Client Support case files from the lead sites were reviewed.

Source: ACIL Allen Consulting 2014.

1.4 This report

This report outlines review findings. It comprises separate chapters on the each of the areas

of focus, before examining what barriers must be resolved for successful trialling of the

model. The structure of this report comprises:

Chapter 2 – Examination of enabling changes

Chapter 3 – Achievement of project outcomes

Chapter 4 – Realisation of intermediate benefits

Chapter 5 – Barriers to be resolved for successful introduction and benefits realisation

Appendixes A, B, and C contain the evaluation framework, detail key data

considerations and outline the project’s stakeholder engagement strategy.



6

2 Enabling changes

This chapter examines the extent to which enabling changes required to build capability and

achieve benefits have been introduced. This includes analysis of the extent to which:

Appropriate clients for Client Support Model were identified and transitioned

Client Support Model was introduced at lead sites with appropriate staff and training put

in place

Key workers were provided with sufficient information to coordinate services

Outcomes-based client driven planning was introduced as part of the Client Support

Model.

2.1 Appropriate clients identified and transitioned

This section includes:

Description of the Client Support client cohort

Overview of the interface between Client Support and established program areas to

support client identification and transition

Assessment of the appropriateness of clients referred to Client Support from established

program areas

Examination of whether key workers were provided with adequate client information at

the time of referral

Timeliness of first contact between key workers and clients

Client cohort

Between establishment of the initial three sites in April 2012, and as of the end of April

2014, 743 Client Support cases were opened. These comprised 418 Managed Support

cases and 325 Guided Support cases (at point of case allocation).

The first case closures occurred in November 2012. Since then there have been 395 cases

closed. These comprised 182 Managed Support cases and 213 Guided Support cases

(support type as at point of case closure).

Figure 4 charts cases opened and closed across the 24 months between April 2012 and

April 2014 for both Guided and Managed Support levels.



7

Figure 4 Cumulative cases opened and closed, by support level

Source: CRISSP Case Allocations Report, total cases period ending April 2014

Noticeable increases in the number of cases opened in July and September 2012 were

linked to establishment and bedding down of the six initial Client Support teams in the first

three lead sites of Dandenong, Geelong and Warrnambool, and the subsequent introduction

of the Guided Support level of service provision in September.

Similarly the increase in case opening activity from October 2013 onwards was linked to the

establishment of three new Client Support teams in the Shepparton and Preston lead sites.

Client Support is designed to work holistically with clients and their families. Recognising

that intergenerational disadvantage can be a characteristic of clients engaged with DHS,

individual Client Support cases can have multiple DHS clients. Within the 743 cases opened

to date, a total of 946 clients are represented, with an average of 1.3 clients per case. Of the

total of 743 cases, 89 per cent of cases involved one client. A breakdown of the number of

clients per case is provided in Table 2.

Table 2 Number of clients per case

1 client 2 clients 3 clients 4 clients 5+ clients

Number of cases 662 27 21 18 15

Proportion of all cases 89% 4% 3% 2% 3%

Source: CRISSP Case Allocations Report, total period ending April 2014

In the testing of the Client Support Model to date, referrals to Client Support have only been

accepted from other sections within DHS (noting that there have been recent developments

in the lead sites to incorporate referrals directly from Disability intake – this will be explored

in a later section of the report). These other program areas of DHS – established program

areas – comprise:

Child Protection

Youth Justice

Disability

Housing

Refugee Minors Program

To understand which established program areas clients had been involved with before they

were referred and transitioned to Client Support, analysis was undertaken using DHS

services and history linked data. The extract was for clients of DHS within all closed Client



8

Support cases, linking DHS delivered service interactions between clients across Child

Protection, Youth Justice, Disability and Housing programs (Refugee Minors Program is not

captured by the linked data).

Figure 5 charts the number of clients that had at least one service interaction with DHS

delivered services, both in the 12 months prior to their commencement in Client Support but

also all recorded DHS program history.

Recognising that disadvantage is dynamic, that circumstance and risk can change, and that

traditionally clients have engaged with DHS for long periods of time, the DHS linked data

was also used to track involvement with DHS delivered programs for as long as the current

data systems allowed.

Figure 5 Number of DHS programsa experienced by clients: in the 12

months prior to commencement in Client Support; and for all

recorded history

a Includes four selected DHS program areas (noting data limitations associated with current data linkage capability outlined in Table B1)

Note: includes a total of 582 clients from closed Services Cases as at the date of extract

Source: DHS services and history linked data, extracted 03/06/2014

In the 12 months prior to commencement in Client Support, DHS linked data indicates

nearly 40 per cent of clients from closed Client Support cases had not had previous

involvement with a DHS delivered program area. A similar cohort had involvement with one

DHS delivered program area. The remaining 20 per cent had involvement in two or more

DHS program areas.

Acknowledging the limitations of the linked data, the analysis of involvement beyond 12

months revealed that for clients from closed Client Support cases, the proportion of clients

with no previous DHS involvement decreased to 32 per cent. Clients with history in only one

DHS program area comprised 33 per cent of the sample. The proportion of clients with

multiple DHS program area involvement increased to over 35 per cent.

Despite broadening the analysis to encompass all recorded DHS program activity, the DHS

linked data indicates a number of clients who have not had a service interaction with a DHS

program area at any time prior to involvement with Client Support indicates a sizeable

proportion of Client Support clients did not meet early referral criteria of required prior DHS

program involvement. However, it is important to note that there are a number of quality

issues associated with the administrative datasets used for this analysis, and that the linking

of data only occurred across four DHS programs within limited timeframes. These limitations

meant that clients with a history of service use in the non-government sector would not have

been identified in this analysis. Given Client Support’s holistic and family centred approach

to practice there could also be clients who may be involved with cases where another family

member has had a history of DHS program involvement, but they themselves have not.



9

Figure 6 charts the number of Client Support clients from the same extract who did have

prior involvement with DHS, indicating the DHS program area with which they had the

greatest level of involvement (determined by number of separate events and event

duration). It provides the breakdown of main DHS program area involvement in the12

months before commencement in Client Support, and also all their recorded DHS program

area history.

Figure 6 Number of clients by main established program areaa involvement:

in the 12 months prior to commencement in Client Support; and

for all recorded history

a Includes four selected DHS program areas, (noting data limitations associated with current data linkage capability outlined in Table B1)

Note: For those with more than 1 program history, the main program was ranked in order of those with the greatest number of events, then greatest overall duration.


Involvement with Housing and Disability between the two timeframes remained relatively

consistent. The number of clients whose main involvement with a DHS program area was

with Child Protection nearly tripled between the timeframes. Of the 582 unique clients

involved with closed Client Support cases, 148, or just over a quarter of the client sample,

had had their main engagement with DHS through the Child Protection Program.

For those clients with a history of DHS program area involvement, the total duration of all

program events is charted in Figure 7.

Figure 7 Number of program events by total duration of involvement with

DHS programa area

a Includes four selected DHS program areas (noting data limitations associated with current data linkage capability outlined in Table B1)

Note: where clients have multiple program events, total duration represents the aggregate of all events




10

Total event duration reflects the nature of the different programs. Youth Justice and Child

Protection activity generally consist of time limited activity or episodes, although individuals

and families can have multiple interactions over lengthy periods of time and across

generations. Long term continuous involvement with DHS typically involves housing and

accommodation or long term disability case management. Examination of the event duration

indicated that nearly 70 per cent of clients’ Housing events were for a total duration of

greater than five years.

It is important to note that this analysis only covers DHS delivered programs, and does not

track community sector delivered services, or engagement with other government funded

and delivered services in other sectors, such as Health and Corrections.

To better understand the client complexity of the Services Connect client cohort, an

overview of the extent to which clients had a statutory order in place at the time of their first

completed star is outlined in Figure 8.

Figure 8 Statutory orders for Guided and Managed Support cases after first

completed Outcomes Star

Note: Progress data consists of 430 cases, comprising 58 per cent of all Services Connect cases

Source: Services Connect Progress Dataset, extracted 02/06/2014

Importantly this analysis begins to indicate client complexity through involvement with other

sectors, through the existence of statutory orders such as Corrections or Justice Orders.

As a whole, nearly 40 per cent of clients had a statutory order identified at the time of their

first completed Outcomes Star (required to be conducted within 30 days of being allocated

to Client Support).

Among Guided Support cases, nearly 14 per cent of clients involved a statutory order.

Among Managed Support cases, over half of the clients involved a statutory order. Given

the design of the Client Support Model and the tiered nature of support, this difference

between the two levels of support is expected.

Interface to support identification, referral and transition

Given the staged trialling of Services Connect, and the absence of an integrated intake or

access point to the model at this stage of testing, the interface between established program

areas and Client Support was central to the identification, referral, and transition of

appropriate clients to Client Support.

The interface between programs has developed significantly over the duration of the pilot,

as well as within each lead site. There was consistency among some processes across

each site, but there was also considerable variation among other processes. The discussion



11

below reflects on early approaches, before outlining practice at the time of the review,

across the lead sites.

Early approaches to client identification, referral and transition

A common feature of testing among the initial lead sites was prioritisation of quickly

identifying and bringing across clients into Client Support.

Established program areas were tasked with working through existing case lists to identify

clients for consideration of referral to Client Support. Referral guidelines were produced to

assist in this process. Considerable effort was also invested in communication and advice

on Client Support and its aims and objectives across the lead sites. Individual and Family

Services Managers were generally involved in the endorsement of referrals to Client

Support.

Despite these efforts, early client identification, referral and transition proved problematic.

Among many established program areas there was frustration and uncertainty regarding

how the Client Support Model was intended to work for very complex clients. This frustration

was underpinned primarily by early experiences of the interaction at the interface between

the two.

Among Client Support staff and management, this confusion in the early stages about client

referral was acknowledged. However this lack of certainty, and the fact that many new staff

in Client Support brought existing clients with them to Client Support meant that highly

complex and high risk clients did come into (and often remained with) Client Support, which

continued to have an impact on the throughput of clients and adherence to the case

duration KPI.

Approaches to client identification, referral and transition and the time of

review

Over time, each site refined and bedded down their approach to client identification, referral

and transition. An overview of the current processes underpinning client identification,

referral and transition is provided below.

Identification of clients

Specific client cohorts within DHS program areas were being targeted as potential sources

for clients. There was consistency across the lead sites for some client cohorts, such as

leaving care clients, or children and young people on settled Supervision Orders. Some lead

sites were expanding their scope of potential client cohorts to include unborn reports or

families with young children with disabilities who were likely to have higher needs as the

child grows older and were accessing respite already (an early indication of family stress).

A number of tools have been developed by some lead sites to assist established program

areas identify clients for referral. These typically consisted of one page flow charts outlining

eligibility criteria to assist established program areas identify appropriate clients

Integration of intake and access points was also occurring. Incorporating Client Support

within Individual and Family Services (IFS) has been a key enabler to this process. It has

allowed for clearer governance structures and enabled innovations like allowing for referrals

directly from Disability Intake to Client Support (where appropriate). This was occurring in at

least two of the lead sites. Similarly it was reported in some sites that introduction of Client

Support and involvement of Housing staff in client identification was driving practice change

and approach in that particular established program area.

All sites reported a more structured process to support client identification efforts in place,

although the extent to which these processes were embedded varied across sites.



12

In the regional sites where only one Client Support team was in operation, and where all

other established program areas were co-located, the processes were more informal and

determined on an as-needs basis than in other sites.

In the larger lead sites, more formal meetings with established program area team

managers occurred where there was discussion about potential clients. IFS Managers,

practice consultants and Services Connect Managers (where they existed) and Client

Support Team Leaders were involved in these discussions.

Referral of clients

Referral of clients to Client Support was principally built on the strength of the relationships

and structures set up to support client identification, and then facilitated through the use of

the CNI tool. While client identification structures were increasingly bedded down across

lead sites, there was varying use and fidelity to the CNI tool across sites, and considerable

disregard for the tool among some established program areas.

However there was also adaptation of the tool. One office has amended the tool to trial use

with the Disability Intake team. In another office the Client Support Team typically try and

engage with the client at the consent stage, and take ownership of the document from the

Strengths and Needs component, rather than capture more information than is required for

commencing engagement of clients.

Despite ongoing issues with the CNI tool, over time, most sites reported that use of the tool

had improved. This was driven primarily by improved relationships built through the shared

identification and referral meetings and discussions.

Transition of clients

To support the transition of clients to Client Support, there were arrangements in some lead

sites for co-visits between Client Support and established program areas staff, and warm

handovers to Client Support at the point of transition.

This was considered particularly important for clients with ongoing statutory orders,

however, there were concerns that this effort was not currently reflected in the design of the

model.

The absence of an integrated Intake point for clients to facilitate entry into Client Support,

and subsequent monitoring, led to the establishment of a number of shadow systems across

lead sites, both within Client Support and established program area staff. These were

discussed and / or sighted in most lead sites during the lead site engagement process. They

were developed to support local information sharing and monitoring of clients.

Enablers and barriers to client identification, referral and transition

From engagement of each of the lead sites, the following key enablers to supporting

identification, referral and transition of clients were identified.

Strong and consistent vertical and horizontal leadership in each lead site, comprising

ownership of the Client Support Model by senior Area management, in turn enabling

engagement and buy in from other established program area managers, both within

Individual and Family Services, but also Child Protection.

Robust relationships and communication between established program area managers

and Client Support Team Leaders, often enabled by pre-existing relationships.

Established processes for managing risk and issues associated with statutory orders,

including co-visits and joint work at the point of transition.

Using opportunities to locate established program area staff in Client Support to cover

short periods of leave or absence, exposing established program area staff to Client

Support practice.



13

Consistency of practice, namely the bedding down of guidelines and approaches, to

provide greater clarity and shared understanding within both established program areas

and Client Support teams.

Barriers that were hindering effective identification and referral of clients were also evident

from lead site engagement and outlined below.

Inconsistent use of the CNI. There was variation in how the CNI tool was used as a

referral tool, and consequently how it was viewed – both by Client Support staff and the

established program staff.

The absence of an integrated client IT system, or single client view results in

considerable double handing of information, potential for oversight of particular client

information, and the development and use of shadow systems within Client Support and

established program areas

Misalignment – both perceived and real – between aspects of the Client Support Model

and established program areas. This included the difference in allocated timeframes for

different levels of support and statutory orders, the use of unendorsed documents and

tools, and the presence of Client Support staff with little experience in particular program

areas.

Appropriate clients referred to Client Support

Recognising that the model has been tested in lead sites and that this has led to a range of

different referral practices and processes, an assessment of client appropriateness was

tested through lead site engagement and the case file review.

Lead site engagement

There was a consistent view across lead sites that referral of appropriate clients in the early

stages of the trial was problematic. As canvassed in previous sections, a range of issues

impacted on the suitability of some clients for Client Support.

The introduction of the most recent referral guidelines and the latest version of the practice

framework were considered critical to providing greater clarity and flexibility to client referral,

and contributing to a greater understanding of the types of clients who may be considered

appropriate by referring programs.

While lead sites conceded that there were ongoing issues around client identification and

referral, at the time of the review senior staff in Client Support considered that most referrals

were now appropriate.

Case file review

To augment lead site views on case appropriateness the case file review collected a range

of data to inform an assessment of client appropriateness for Client Support.

Recognising that the two tiers of support in scope for this review were designed for clients

with complex needs (Managed Support) and low to moderate needs (Guided Support), and

clients who would benefit from a more coordinated and integrated approach to services, the

case file review examined client complexity and the extent of engagement with DHS and

NGO delivered services.

Whether clients had a statutory order in place and their length of involvement in DHS at the

time of referral provides an indicator of client complexity. Figure 9 charts the extent to which

clients identified in the case file review had a statutory order in place, and the number of

DHS services involved at the time of referral.



14

From the case file sample, 30 per cent of cases had some form of statutory order in place at

the time of referral. 40 per cent of cases had multiple DHS services involved prior to referral.

For Guided Support cases, 3 of the 22 cases in the sample had a statutory order at time of

referral. One of these clients was also an NDIA client. For Managed Support cases, 10 of

the 20 cases in the sample had a statutory order at time of the referral.

Across the 42 cases, 40 per cent were involved in two or more DHS services at the time of

referral. Just over half of the cases had involvement with a single DHS delivered service.

There were two cases in the audit where there was no prior DHS involvement identified. For

one case this because they had only just been referred to Client Support, directly from the

trial site’s Disability Intake area. The other client had disengaged from Client Support soon

after referral and before the key worker had opportunity to collect relevant information about

their previous service history, which the audit would have then picked up.

Figure 9 Statutory orders and number of DHS services at time of referral for

the case file audit

Source: Case file review

Data indicating involvement with funded community sector and non-government services

were also collected. The data indicated that in 26 of the cases there was NGO service

involvement. For the remaining 16 cases there was either no NGO involvement or it was not

apparent to the case file reviewer that there was NGO involvement at the time of referral.

When DHS and NGO service involvement is combined, 31 of the cases had multiple lines of

service delivery at time of referral to Client Support.

Figure 10 tracks the length of DHS service involvement prior to referral. Nearly half of the

clients with Child Protection involvement, and the majority of clients with Disability and

Housing involvement had a history of involvement with those services of five or more years,

indicating long term disadvantage and involvement with DHS.



15

Figure 10 Length of client involvement in DHS services prior to referral

Note: Types of involvement in DHS services exceeds the total number of cases in the review, reflecting that 17 of the 42 cases had involvement in multiple services


From the sample of 42 cases, it was identified that in over 60 per cent of the cases other

family members of the client had previous DHS service involvement, indicating another layer

of client complexity and the existence of long term disadvantage.

After transition to Client Support, 2 of the 42 cases in the sample were subsequently

deemed inappropriate for the model by Client Support and returned to established program

areas.

Evidence collected from the case file review supports the views of lead sites that the

majority of more recent cases referred to Client Support were considered appropriate for

Client Support.

Key workers provided with adequate information at time of referral

At point of referral and transition of clients, key workers are meant to obtain as much client

information as possible from the referring DHS established program area. This is principally

collected from the CNI tool, but in practice is also obtained from the referring worker, and

from relevant DHS client data systems.

This issue was explored with Client Support staff. Figure 11 charts their views on the

adequacy of information provided by established program areas at the time of referral, to

support the transition of clients into Client Support.

At the time of review, over 60 per cent of staff agreed that they now received adequate

referral information.

Figure 11 Extent to which Client Support staff agree they receive adequate

information at the time of referral of clients, to support their

transition into Client Support

Source: Client Support Workforce structured questionnaire data

Most lead sites had undertaken work to better inform established program areas and Client

Support staff in the use of the CNI tool. The tool was used by staff as an encompassing



16

referral, review, and case closure tool, though some users of the tool cited this as a design

flaw.

The quality of information obtained through the CNI was an issue frequently cited by Client

Support staff. Even where Client Support staff agreed there had been improvements, they

cited variability in the level and quality of information as an ongoing issue for them. These

views were echoed in the lead site engagement consultations.

Timely first contact

The case file review assessed the timeliness of contact between referral and first contact

between the client and the key worker.

Table 3 outlines the time elapsed between referral, allocation, and first contact for each of

the 42 cases in the sample.

Table 3 Time elapsed between referral / allocation / first contact

Time elapsed

between: Not known Same day

Within one

week

Within two

weeks

Longer than

two weeks

Referral and allocation

10 11 5 7 9

Allocation and first contact

6 8 13 6 9

Referral and first contact

12 1 7 7 15


In 12 of the 42 cases it was not possible to determine how much time had elapsed between

referral of the case and first contact from the data. As identified in the previous sections, the

practice of client identification, referral and transition differed across lead sites. For example,

in some sites, client consent conversations were conducted by both established program

area staff and Client Support staff, and could constitute the first contact.

In other instances, cases may have only been allocated once the key worker had conducted

the first visit or discussion, or cases had come from established program areas with the key

worker when they started in Client Support. This complicated the recording of these dates.

The current practice framework highlights the importance of a well-managed and seamless

transition from referring program to Client Support. Contact and engagement with the client

is recommended to be actioned promptly.

Of the 30 cases where the time of referral and first contact was recorded, half had less than

two weeks elapse between referral and first contact.

The average length of time for the 30 cases where it was possible to determine the length of

time between referral and first contact the average length of time was 2.8 weeks.

The longest time period to elapse between referral and first contact was 9.7 weeks.

2.2 Appropriate staff and training in place


Overview of the Client Support workforce

Description of the workforce recruitment processes, and workforce learning and

development for Client Support staff

Assessment of the extent to which Client Support positions were filled

Assessment of the extent to which Client Support staff were appropriately skilled



17

Measurement of the extent to which Key Workers had the required practice guidance

and supervision they needed.

Client Support workforce

Given initial testing of Client Support has been internally focussed, the Client Support

workforce is drawn largely from DHS established program areas and broadly reflects their

skills base and practice perspectives.

Client Support experience

Across the five lead sites, ex-Disability, Housing and Child Protection staff are the most

represented. The spread of staff across lead sites was relatively balanced, however there

were exceptions, with limited Child Protection experience in some sites.

It was evident from engagement with the Client Support staff that teams valued having

multidisciplinary members, with staff appreciating the ability to call on peers within their team

with different skillsets and experience for practice advice and guidance.

A small number of Community Sector secondees had been recruited to Client Support. In

lead sites where they have been recruited, there was positive comment in the consultations

about the unique skillset and mindset they brought to the Client Support teams.

Client support staff qualifications

Minimum qualification requirements for commencing as a Guided Support key worker is a

Certificate IV in a relevant discipline, or working towards completion of that qualification.

Nearly all staff had either this qualification or higher, noting that for 7 staff members the level

of qualification was not known.

Over 60 per cent of the current workforce had a Bachelor degree or higher qualification.

In recruiting to Client Support there were a number of issues that constrained lead sites’

ability to recruit appropriate staff. These included external issues such as regionality, which

limited the pool of qualified staff to choose from, and the localised impact of introduction of

NDIA in Barwon.

Internal factors included the organisational restructure of the Department, implementation of

the Child Protection Operating Model, and the quarantining of certain established program

areas in some Divisions preventing recruitment and release of staff to Client Support.

Workforce learning and development

Given the intent to test the Client Support Model during these early stages the lead site trial,

workforce recruitment and learning and development was conducted within tightly controlled

parameters.

Recruitment

Recruitment to Client Support was conducted through an Expression of Interest (EoI)

process. This was supported through advice and guidance from Central Office regarding

FTE allocation, position descriptions, roles and responsibilities, and salaries.

Notwithstanding this level of prescription to recruitment, there was some local variation in

approach to recruitment.

This included providing information sessions on the Client Support model to established

program area staff to generate interest. In some instances established program area



18

managers were asked to identify staff who they thought would be suitable to transition over

to Client Support. Across the lead sites the response to Client Support was positive,

generating interest and applications to come join the Client Support team. In some sites

recruitment was sequenced to ensure new Client Support Team Leaders could contribute to

recruitment decisions.

Community sector secondees were used in three of the five lead sites.

Guided Support positions were initially seen as particularly attractive as they offered

pathways to new opportunities for staff who did not have the advanced case practice

requirements associated with Managed Support positions.

Some established program area managers were reluctant to release staff at the Managed

Support level, as they were often considered their most experienced team members. There

was a conscious decision in some lead sites to ensure that Client Support did not drain

established program areas of their most capable staff and leave them vulnerable.

Learning and development

To aid workforce learning and development, a substantial learning and development

program was developed to support Client Support staff in each site. It comprised:

Introduction to Client Support

CNI training

Motivational interviewing

Outcomes Star

IT systems (CRISSP and Outcomes Star)

Single session training

Family Sensitive Practice

Community and Economic Participation

Outcomes Star Practice Review

Bridging courses and programs were also offered for new starters to Client Support in the

three initial lead sites when they were first established.

In analysing Services Connect learning and development data (collected locally, and

coordinated centrally by the Services Connect Design team) it was evident that most key

workers and team leaders had participated in Motivational Interviewing, Outcomes Star,

CRISSP and Outcomes Star IT training, and Family Sensitive Practice. From the same

centrally held dataset it appeared that less than 40 per cent of the workforce had undergone

training on the CNI (at the time of this review).

Regular key worker forums had also been facilitated to provide the opportunity for staff from

different lead sites to come together and share learnings and provide operational feedback

to Central Office. There has been internal monitoring of the Client Support Learning and

Development program.

There has been considerable effort at the local Area level to support learning and

development activities for Client Support staff.

This included the conduct of regular reflective practice sessions facilitated by Practice

Consultants. Reflective practice was valued by Client Support staff, and allowed for team

discussion and workshopping of potential strategies to assist with complex cases or issues.

Other local learning and development activities undertaken included:

Role play sessions to further practice Motivational Interviewing techniques



19

Sessions on the development of Client Support plans and writing up of case notes

Working with Aboriginal staff in the Area to improve cultural competence

Training on the Best Interest Framework for Child Protection and the Disability Act

Leaving care training

Refresher sessions on using CRISSP.

Most Client Support Team Leaders and senior Area management stressed the importance

of the Practice Consultant role to the running of these activities. They were also seen as

central to driving and monitoring practice change among the Client Support key workers,

moving them from a traditional DHS case management type approach to a more strengths

based, outcomes focussed way of working.

Client Support staff positions appropriately staffed

The extent to which the Client Support model was fully staffed is one of the program’s KPIs.

The benchmark for the program is 90 per cent of staff in place measured against agreed

FTE positions.

Figure 12 charts the program’s performance against this KPI.

Figure 12 Proportion of agreed FTE Client Support staff in place – all sites

Source: Services Connect monthly KPI reports

Historically, Guided Support was below target, but had increased close to target in 2014.

Since July 2013, the proportion of Managed Support staff in place tracked closely and

towards target over time.

As part of the Client Support Model design and testing, caseloads were calculated to allow

for an estimated load within key worker teams. These team targets were built on a caseload

of 15 cases for Guided Support key workers and 10 cases for Managed Support key

workers.

At the time of review, the current average caseload per FTE Client Support key worker was

7.9 cases. This comprised 9.8 per Managed Support key worker but only 5.7 per Guided

Support key worker.

Over the course of testing, most lead sites found less difficulty recruiting Managed Support

staff than recruitment of Guided Support staff.



20

From engagement with lead sites it was evident that the divide between Guided and

Managed key workers was a malleable one.

There was frequent mention of instances where – because of risk escalation issues or other

developing case complexities, or simply to challenge staff, key workers had mixed case

loads of Guided and Managed cases. Where Guided Support key workers were working

Managed Support cases there was co-allocation to another Managed Support key worker or

Team Leader to provide advice and support.

Client Support appropriately skilled

This section examines whether Client Support staff were appropriately skilled for their role,

measures their experience of induction and learning and development activities undertaken,

and assesses their level of understanding of statutory requirements.

Lead site engagement

At the time of review, most senior managers engaged in the lead sites considered that their

Client Support teams had, or were close to having, the skills required to deliver all elements

of the Model.

Staff had undertaken significant amounts of training to develop their skills in all areas, and

teams were skilled to deliver the Model.

Senior managers commented positively on the resilience of staff, Team Leaders and

Practice Consultants in particular, in the way in which they had supported bedding down of

the Model, and provide a practice link between the operational component of the Model and

the Design team in Central Office.

Notwithstanding the views of the team as a whole there was acknowledgement that the

skills and capability of staff could still be improved.

Client Support perspectives

Most staff considered they had the skills needed for Client Support. Figure 13 charts the

reflections of Client Support staff on the extent to which they agree they were appropriately

skilled to deliver all of the key components of the Client Support Model.

Figure 13 Extent to which Client Support staff agree they now have the skills

needed to deliver all of the key components of the Client Support

Model.


While many staff rated themselves highly on the scale, they also acknowledged that there

were still significant areas of knowledge and skills they needed to pursue in areas or sectors

outside of their original program area.

Some key workers identified that they had experience operating under similar models, such

as within the community sector, or in other social work type occupations. Expectations of the

Model was another area of significant comment, with many key workers indicating they



21

thought they knew what the role would comprise, but that it had proved quite different in

practice to what they had originally expected.

Key workers identified that they faced some challenges due to practice tools not being

available to them when the Model was first introduced, and that they had had to grapple with

learning how the Model was meant to operate at the same time that it was undergoing

further change and development.

Established program area views

Just over half of the established program area managers agreed that appropriately skilled

staff had been recruited to Client Support.

At the time of the review, there was acknowledgement that Client Support teams had made

significant improvements regarding their skills in all program areas, and acknowledgment of

the inherent difficulties faced by key workers in having to develop skills across different

areas of practice and expertise.

Induction, learning and development

As outlined in an earlier section, an established and centrally developed learning and

development program has supported trialling of the Client Support Model.

Figure 14 charts the level of agreement among the Client Support Workforce on the

adequacy of induction training (or bridging programs if they commenced before the

introduction of any formal induction training), and the subsequent Client Support learning

and development opportunities they have experienced.

Figure 14 Extent to which Client Support staff agree that induction training

(or bridging programs), and subsequent learning and development

opportunities provided them with the skills they needed to deliver

Client Support


A large number of key workers across all sites commented on the training provided, with

many of them acknowledging that the learning and development opportunities had been

useful but also identifying ways in which it could be further improved.

Significant numbers of staff considered that staff training at induction was rushed; many felt

overwhelmed with the amount of information that was delivered over several sessions within

a short space of time. The delivery of training in this manner also did not allow staff to fully

take on board and apply what they were learning. Some staff identified that they would like

to undertake the training again to enable them to further build their skills and apply further

learnings.



22

Staff described that in the early days of model testing, they struggled to implement this

training in a practical way because there was little guidance or framework within which to

operate, and many aspects of the Model were still being developed.

The usefulness of Motivational Interviewing training was also mentioned frequently. It was

considered to have provided key workers with a good introduction and understanding of the

approach, but given its centrality to the Model, there was considerable appetite from key

workers for further opportunity to engage in more in depth and ongoing training.

Understanding of statutory requirements

A considerable number of clients in Client Support have statutory orders of some description

in place. Given this, Client Support key workers’ knowledge and understanding of relevant

legislation and statutory requirements will impact on how they work with the client and

coordinate services.

Figure 15 charts the extent to which the Client Support Workforce agree they have a good

understanding of the statutory requirements of their clients.

In the last three months prior to the review, there was strong agreement by the Client

Support workforce that they had a good understanding of the statutory requirements of their

clients.

Figure 15 Extent to which Client Support staff agree they have a good

understanding of the statutory requirements of their clients


Examining the survey data by Client Support professional background indicates that most

Child Protection and Youth Justice agreed they had a good understanding of statutory

requirements. Among Client Support staff from non-statutory backgrounds, the level of

agreement was over 60 per cent.

Between Client Support levels, Managed Support key workers were confident about their

understanding of statutory requirements. Guided support workers far less so. Whilst at the

time of review the majority of key workers considered that their knowledge had improved

significantly in this area, most felt they had more to learn.

Established program area staff considered that the understanding of Client Support staff of

relevant statutory requirements had improved significantly over time. These results were

informed by their knowledge and relationship with staff in Client Support.

Key workers have the practice guidance and support needed

Quality practice guidance and support underpins core aspects of the Client Support Model

and the current version of the practice framework.

Figure 16 charts the extent to which the Client Support workforce agreed they received the

practice guidance and support they needed to successfully deliver the Client Support

service.



23

Figure 16 Extent to which Client Support staff agree they receive the practice

guidance and support they need to successfully deliver the Client

Support service


Feedback across all sites suggested that practice support had improved significantly,

particularly following the release of the latest version of the Client Support practice

guidelines.

Reflective practice sessions and the role of the Practice Consultant as a trouble-shooter and

source of advice were singled out by many of the respondents as central to this issue.

Client Support staff also reported being more comfortable about the model as it has

developed and been bedded down. They reported beginning to feel more confident about

the consistency of guidance and support they are receiving from Team Leaders and

Practice Consultants.

2.3 Key workers provided with sufficient

information


Overview of process to enable planning and coordination of services across lead sites

Examination of the interface between Client Support and established program areas and

the extent to which it supports information sharing and service coordination

Assessment of whether key workers have sufficient information about services available

for their clients

Planning and coordination across programs

A range of planning and coordination activity occurs across lead sites. At a manager level

these coordination activities were typically rolled into formal meetings and structures that

have been established to support client identification and referral.

At a client level, planning and coordination was primarily conducted through the care team

meeting. In the case of managing and monitoring statutory delegations of clients in Client

Support, there were a number of different approaches in place across lead sites.

Care team meetings

Care team meetings are the principal means with which to coordinate and plan multiple

services and activities for clients.

Across lead sites, care teams were recognised by Client Support and established program

area staff as the key platform for information sharing, planning, coordination and review of

services, and monitoring of progress towards outcomes.



24

However, they are not a required element of the Model, and Client Support staff commented

that for clients with low-level needs, there may not be a need for regular care team

meetings, or for a care team meeting to be established at all.

Established program area staff were participating in care team meetings organised and run

by Client Support where they were invited to do so. However, there was considerable

comment on the length of time it took to establish and run care team meetings for clients

who needed them, particularly in the early days of the trial. Established program area staff

acknowledged that, at the time of review, care team meetings appeared to be run and

coordinated in a far better manner.

Statutory delegation

Most sites have identified specific Child Protection and Youth Justice liaison officers or

teams to work with Client Support, to hold and monitor statutory delegation for clients with

statutory orders.

In some lead sites, senior Child Protection Practitioners perform this role. In others, a team

of Child Protection practitioners have been allocated this task to ensure periods of leave are

covered.

This approach ensures statutory considerations and monitoring of risk is handled by an

appropriately skilled and authorised worker. However, due to associated restrictions on

statutory client IT systems, considerable work and double handling of client information by

the statutory worker in updating and recording client activity and information against the

statutory case plan is generated.

Statutory workers were also concerned about accountability to the Children’s Court. Child

Protection and Youth Justice workers considered DHS could be particularly vulnerable in

instances of crisis where statutory workers would be required to explain case activity and

decisions to the Court that they had not been directly involved in.

There were also concerns across established program area about the adequacy of this

approach to monitoring delegations if the Client Support model was scaled up across each

Area and across different offices and sites.

Interface to support information and sharing and service coordination

Effective case coordination is dependent on good information sharing processes and

practice.

A common feature of lead site engagement was a focus on the issues associated with

having to navigate multiple client IT databases, and how this inhibited information sharing

and heightened risk for clients, workers and DHS more broadly.

This issue was tested with both Client Support staff and established program areas. Figure

17 charts the extent to which the Client Support workforce agreed they can access and

share client information when they need it.



25

Figure 17 Extent to which Client Support staff agree they access and share

client information when they need it.


In the three months prior to the review, over 80 per cent of the Client Support workforce

agreed they could access and share client information when they needed it.

Figure 18 charts the extent to which established program areas agree that Client Support

and established program area staff access and share client information when needed.

Figure 18 Extent to which established program areas agree that Client

Support and established program area staff access and share

client information when needed

Source: Consultation data from 22 established program areas across the 5 lead sites

A significant number of staff commented on the limitations of not having IT system which

easily allowed information sharing between different DHS program areas. Often this lack of

integrated systems led to information being shared less often between Client Support and

established program areas, as well as creating issues around the identification of clients

who may be accessing multiple DHS services. Established program areas cited examples

where they did not know that their clients were involved other established program areas.

Despite the frequency of these issues, the survey data and established program area

feedback indicates that staff have found the required workarounds to access and share

information when they need it.

This was particularly apparent in the regional sites, or those sites where Client Support

teams are co-located with established program areas, enabling better information sharing

practices. Smaller numbers of staff, often in regional areas also meant that there were

stronger relationships between staff, which also assisted with information sharing.

While Client Support staff were finding ways to make information sharing work within their

lead sites, there are implications about the adequacy of these very person dependent

approaches if the model were to be scaled up.

Key workers have sufficient information about services

In delivering an integrated service delivery model, key workers were required to understand,

navigate and work across different program areas. Figure 19 charts the extent to which the



26

Client Support workforce agreed they had sufficient knowledge about their local human

services system with which to develop holistic plans with their clients.

Figure 19 Extent to which Client Support staff agree they have sufficient

knowledge about their local human services system to develop

holistic plans with their clients


In the three months prior to the review, more than 80 per cent of Client Support staff felt they

knew enough about the local service system to properly plan and coordinate services. A

large number of staff conceded they still had a lot to learn and understand about their local

human services system. Some staff also felt overwhelmed regarding the volume of

information about their local service system that they had to be across.

When comparing responses across Managed Support and Guided Support key workers

across all sites, there was a higher degree of familiarity and knowledge of the local service

system among Managed Support key workers than Guided Support key workers.

Some team leaders identified that whilst staff were beginning to gain a greater

understanding of the service system, there was still a need to establish and develop

relationships more broadly within the community service sector to fully tap into and leverage

the local human services system.

2.4 Outcomes-based client driven planning

introduced


Description of the extent to which Client Support clients transition between levels of

support, and case closure

Overview of client engagement processes in the lead sites

Assessment of whether client driven planning underpins Client Support practice

Transitions between support levels

Client Support is premised upon a tiering of support between Managed Support, Guided

Support, and Self-Support (not yet tested).

A desirable outcome of Client Support is the addressing of issues impacting on a client’s life,

and establishment of client capacity and appropriate level of independence that allows

clients to either move to a lower level of support, or exit Client Support.

Similarly, identification of new issues or emerging client complexity may necessitate

transition to higher level of support.

Recognising that only Managed Support and Guided Support were being tested, Figure 20

charts the number and proportion of case transitions between Managed and Guided

Support levels for active and closed cases.



27

Figure 20 Proportion of case transitions between Managed and Guided

Support

Note: includes 365 cases with at least one progress transition reported; those cases with a single allocation are excluded

Source: CRISSP Case Allocations Report, extracted 13/05/2014

Transitions between levels of support were occurring for some cases over the course of

their duration.

For most cases there was no change between support levels.

For those that did experience a change, there was a higher proportion of clients that

experienced a desired transition from Managed to Guided Support levels, than those who

experienced a transition from Guided to Managed Support.

For closed cases with one progress point (the most numerous column) the proportion of

cases experiencing a downward transition from Managed to Guided was twice the

proportion of cases that featured an escalation from Guided to Managed Support.

Client engagement and participation

Within a voluntary, client driven service delivery context, the extent to which client

engagement and participation is supported is fundamental to the success or otherwise of

the Model.

Client Support Team Leaders and key workers conducted much of their client engagement

and work within an outreach framework. Client Support staff identified that engagement with

clients in their own homes or environments they were comfortable with, was a key factor in

establishing rapport (particularly in the early stages), building relationships and supporting

clients to achieving identified outcomes.

However, there were a number of practice and work implications in undertaking outreach

work, primarily related to a lack of mobile technology and integrated IT systems.

This included having to take hard copies of planning documents with them to visit clients,

record information manually during the engagement, and then re-enter this information into

IT systems once workers returned to the office. The absence of mobile technology and

tablets, and the ability to do this work once and in place in the client’s home increased the

time they spent on these administrative and support activities.

Key workers were engaging many of their clients in environments outside of the office.

Asking clients to come to DHS is identified as working in the traditional DHS manner and is

not seen as particularly conducive to effective client engagement.

This approach, using existing limited IT resources, can be time-consuming. It is unclear how

big an impact outreach activity could have on assumed timeframes currently built into the



28

Model, particularly for regional areas where there can be significant travel time required to

meet clients in their own home, or if the Model is expanded.

Client driven planning underpins practice

Program performance on client driven planning

Client driven planning is a fundamental design feature of the Services Connect service

delivery model.

To prioritise client driven planning and embed it within practice, a specific Services Connect

KPI has been established to monitor timely completion of Outcomes Stars and Case Plans.

The KPI requires that 85 per cent of cases have finalised stars and plans in place within 30

days.

The issue of client driven practice was a key focus of the Client Support staff questionnaire.

This included examination of the extent to which Client Support staff considered they had a

comprehensive understanding of client need; whether clients were experiencing client driven

planning; the extent to which Client Support staff have the tools to enable client driven

planning; and – reflecting the significant practice change encompassed by the Services

Connect delivery model – whether Client Support staff feel prepared and supported for client

driven planning.

Client Support staff

Figure 21 charts the extent to which the Client Support workforce consider they have a

comprehensive understanding of their clients’ needs.

Figure 21 Extent to which Client Support staff agree they have a

comprehensive understanding of their clients’ needs


In the three months prior to review, over 95 per cent of staff felt that they had a full and

comprehensive understanding of their client’s needs.

Notwithstanding these results, many staff qualified their rating with comments about further

developing their skills and use of separate tools to better improve their understanding of

client needs. Motivational interviewing was repeatedly identified as a particularly useful

approach to working with clients and better understanding their needs.

Other key factors that Client Support staff identified as impacting on their ability to identify

and understand client need was the quality of information provided to them at the time of

referral, and the variety of client need within their caseloads. Staff also commented on the

length of time it can take to build rapport and engage with clients and how the time this can

take does not align with KPI requiring finalised plans and stars.

Figure 22 examines key worker views and charts the extent to which the Client Support

workforce agree their clients are experiencing client driven planning.



29

At the time of review, over 80 per cent agreed their clients did experience client driven

planning.

Figure 22 Extent to which Client Support staff agree their clients are

experiencing client driven planning


There was also considerable feedback from staff on the challenges in enabling client driven

planning.

Client readiness for client driven planning was a key feature of the qualitative data collected

through the questionnaire. Clients are referred to Client Support with differing readiness and

capacity for change. This can mean considerably more work with some clients developing

rapport and moving them towards being ready to discuss their own needs and participate in

planning.

The presence of statutory orders and mandated requirements were also identified as

particularly challenging for workers to integrate into client driven planning. In Geelong, the

existence of NDIA individual plans limited the extent to which client driven planning could be

undertaken as part of the Client Support Model, with a client’s needs already identified and

planned for before they came across to Client Support.

Figure 23 charts the extent to which the Client Support workforce consider they had the

tools to enable outcomes based, client driven planning. At the time of review over 90 per

cent of staff agreed they did have the required tools.

Figure 23 Extent to which Client Support staff agree they have the tools to

enable outcomes based, client driven planning


Overwhelmingly, Client Support staff identified that there had been significant improvement

in the tools and guidelines available to enable client driven planning. Whilst some of these

tools were available to staff when they commenced working in Client Support, many felt they

had become better able to use them due to training undertaken, which built confidence over

time and familiarity with the tools.

However, staff also identified that there was still learning to be done in relation to outcomes

based client driven planning. Figure 24 charts the extent to which the Client Support

workforce felt supported and prepared for client driven planning. At the time of review, just

over 80 per cent of the workforce agreed that they felt supported and prepared.



30

Figure 24 Extent to which Client Support staff agree they feel supported and

prepared for client driven planning


At interview, a significant number of Client Support staff reported that they had always

worked in a client driven manner, but that Services Connect now provided them with the

tools, environment, and time to work in a family centred and intensive way.

Feedback from key workers also indicated that leadership from senior staff was a critical

element of them feeling supported to deliver client driven planning. Key workers from some

sites highlighted that their local senior management had been exceptional in enabling and

supporting them to trial the model — helping them to overcome issues where they arise.



31

3 Project outcomes

This chapter examines the extent to which the Client Support project outcomes are being

achieved. This includes analysis of the extent to which:

Clients are allocated a single key worker and have an integrated service plan

Holistic support is provided to clients based on a comprehensive assessment of needs

Clients are allocated to service response level reflecting their level of need

Services are planned and delivered to achieve specified client outcomes

3.1 Allocation of a single key worker and integrated

service plan


Analysis of the extent to which clients are allocated one Key Worker who acts as the

primary contact and intervener for the client

Analysis of the extent to which clients have a single integrated case plan

Key worker acts as the primary contact between the client and service

system

The role of the key worker is fundamental to the Client Support Model. They are the primary

contact between the client and the broader service system. The key worker enables client

driven planning, drives coordination and consistency in service provision, and reviews and

monitors client progress.

The role and activity of the key worker was assessed through the Client Support

Questionnaire, consultation with established program areas in lead sites, the case file

review, and Client Support data.

Client Support staff views

Figure 25 charts the extent to which the Client Support workforce agree they have now

become the main point of contact between their clients and the broader human services

system. Approximately 90 per cent of staff agreed that they were the main point of contact

for their clients at the time of review.

Figure 25 Extent to which Client Support staff agree they have now become

the main point of contact between their clients and the broader

human services system




32

In those instances where Client Support staff considered they were not the primary contact

(or who reported problems in establishing themselves as the primary contact) the chief

reasons included:

Established program area staff members continuing to be the key point of contact, either

by design or because the client had an established relationship

Clients were in residential care (primarily disability), where the key point of contact was

staff at the facility

Client preference and desire to have more control over the services and workers they

access

Through engagement with the Client Support staff, it was evident to the review team that

there were some differences in interpretation among Client Support staff about what defined

being the main point of contact between clients and the broader human services system.

Some staff identified they were driving and monitoring coordination of services, but were not

the main point of contact for the client, or that while they were nominally the main point of

contact for all their clients, this was not the case in practice.

Where statutory orders were in place, Client Support staff indicated this led to an increase in

the number of workers or case managers involved in the client’s life, due to the presence of

both an established program area worker monitoring the delegations — although in some

instances they indicated that the statutory workers were less directly engaged with clients.

While other case workers or managers could still be involved, the increased service

coordination meant that involvement was only when required.

During interview some managers described that clients were not experiencing less workers

or case managers involved in their lives. Consistent with the views of Client Support staff,

comments mainly related to those clients on statutory orders which still required involvement

from established program area staff.

A small number of managers did describe that while there may not have been a reduction in

workers or case managers involved, there was definitely a more coordinated and planned

approach to services.

Case file review

Table 4 outlines the role and activity of Client Support key workers in the cases identified

through the case file review sample.



33

Table 4 Key Worker role and activity in care teams

Guided support Managed support Total

Regularity of care team meetings

Client does not have a care team 18 8 26

Weekly 1 1 2

Fortnightly - 2 2

Monthly 1 6 7

More than monthly 2 3 5

Key Worker chairs the care team meetings (of the 16 cases where there is a care team)

Yes 3 9 12

No 1 3 4

Key Worker takes on the client support activities

Yes 4 11 15

No 3 1 4

Unclear / no response 15 8 23

Source: Case file review of 42 Client Support cases

Of the 42 cases, 26 did not have a care team established. Reasons cited for the absence of

a care team for some of these cases included:

Client isolation

Lack of client complexity and services involved

Client disengagement from Client Support.

Eight of the cases without a care team were Managed Support cases. In six of these cases

there were multiple services and programs before and during involvement in Client Support.

Given the importance of the care team within the Model as the platform for driving

consistency in multiple service provision, it was unclear why there was no care team in

place for these cases.

Where a care team had been established, Client Support key workers chaired 75 per cent of

the care team meetings.

From the analysis of the case notes undertaken by each of the lead sites, it was evident the

key worker was the primary intervener and point of contact for the family in 15 of the 16

cases where a care team had been established, and was responsible for client support

activities arising from decisions made by the care team.

Program data

To determine if key workers were acting as the primary contact between clients and the

service system, analysis of data related to service management for closed cases was

undertaken.

Over the duration of the case, there were indications that clients were increasingly

managing their own service involvement from completion of the first star to exit. Although

these results were limited by the large proportion of unknown/missing responses (20-40

percent at various progress points), the proportion of cases managed by clients consistently

increases across the case duration.

By combining the total number of services that were either provided by a Client Support key

worker or by another specialist worker, between point of first completed start and exit, 28

per cent of the closed Client Support cases experienced a decrease in the number of

workers over that time. 15 per cent experienced an increase in the number of workers over

that time. There was little or no change for the balance.



34

Clients have a single integrated case plan

One plan is another core component of the Client Support Model. By integrating the key

actions and activities that clients need into one document, the key worker can ensure that

services are working in a transparent and unified way.

The degree to which clients were experiencing a single or integrated case plan was

examined with Client Support staff and through analysis of the Services Connect Progress

dataset.

Figure 26 charts the extent to which the Client Support workforce report that clients had a

single case plan that enabled coordination of the full range of support and services their

clients need.

Figure 26 Extent to which the Client Support workforce report that clients

have a single case plan that enables coordination of the full range

of support and services their clients need


Feedback from Client Support staff highlighted some divergence in views on whether single

case plans were in place for clients.

Overall, staff indicated that further work was required to ensure that single case plans were

not only in place for all clients, but were effective in enabling the coordination of a full range

of supports for clients. Challenges they faced to developing a single case plan for clients

included the requirements of:

Statutory orders and court ordered case plans

Community service agencies that required their clients to have their own case plan

targeted to service they were providing, such as mental health plans

And in Geelong the NDIA individual needs plan.

Most workers took the approach of integrating the range of plans a client had — providing

an overarching case plan for clients. However, many workers seemed unsure as to whether

this was the right approach, and were looking for greater clarity of how they should go about

reflecting the needs of multiple services.

Plans in use reported in Client Services Progress data

Data is collected in the Services Connect Progress dataset about whether a plan is in use

with each service that is recorded as being involved with a client. This data was interpreted

with considerable caution due to the level of missing data and issues relating to

misinterpretation of this question by key workers at the point of data entry.

Notwithstanding the data limitations, analysis indicated that at the first completed star, an

average of two plans were in use for guided support cases, and two to three plans for

Managed Support cases.



35

The average number of plans decreased over progression to exit for Guided Support cases,

but had increased for Managed Support cases at exit.

Data on the extent to which case plans had been integrated at each selected progress point

was also analysed. Of those services reported with a plan in use, 14% were integrated at

the first completed star. The majority of the remaining 86% were missing a response for this

element so no conclusion could be drawn with confidence.

Given the extent of missing data and interpretation issues highlighted, it is difficult to

interpret these results with confidence. The data elements described above will benefit with

an improvement of data collection practices, in particular improvement in workers’

interpretation of this data element at the time of collection to improve consistency and

completion of ‘plans in use’ and ‘plans integrated’ data.

3.2 Holistic support based on comprehensive

assessment of need


Analysis of the extent to which clients experience one comprehensive assessment of

need

Measurement of whether clients are experiencing holistic support

Clients experience one comprehensive assessment of need

The current stage of testing of the Client Support Model makes measurement of the extent

to which clients were experiencing one comprehensive assessment problematic. Clients

were being referred from existing DHS programs. As outlined earlier many have a long

history of involvement with DHS.

Until further elements of the Services Connect Model are tested, and an integrated Intake

system across the Model is developed, the majority of clients will have already ‘told their

story’ at least once to other services prior to engagement with Client Support.

In the absence of this integrated Intake point, the CNI tool was being used as the tool for

comprehensive needs identification for entry to Client Support.

As is evident from much of the material outlined in the previous chapter, the use of the CNI

and adequacy of the information collected through it at referral varied considerately.

This was confirmed through data collected through the case file review.

Of the 42 cases sampled in the case file review, 18 cases (9 Managed and 9 Guided) did

not have a CNI.

For those cases where there was no CNI, lead sites reported that they had either never

received a CNI from established program areas, or that Client Support staff had brought

those particular cases over to Client Support from their previous role, which meant that a

CNI was never completed. Some cases were from early 2013 before the CNI tool was

introduced.

Even allowing for these issues, the absence of a CNI among this number of cases is

significant.

In the 24 cases where there was a CNI, the average number of needs and strengths

identified at entry to Client Support was 7.5. The median number was 8.



36

Clients are experiencing holistic support

The extent to which comprehensive assessment of need was enabling clients to experience

holistic support was impacted by issues canvassed in the section above and throughout the

previous chapter.

Confirming much of the data and perspectives collected from the Client Support workforce

about inadequacy of information collected at point of referral and subsequent identification

of new need, Figure 27 charts average needs for clients at completion of the first Outcomes

Star.

Figure 27 Average number of needs identified at completion of first star, by

reason for referral and level of need

Note: Progress data includes 430 cases with a record of first completed star, comprising 58 per cent of all Services Connect cases.


The data indicates that on average one need was recorded as the main reason for referral

for Guided Support cases, and just over two needs on average for Managed Support cases.

After transition to Client Support, engagement with the key worker, and completion of the

first Outcomes Star, the average number of needs identified for Guided Support was over

seven needs, and for Managed Support was over eight needs.

Using the case file review sample, service patterns immediately post referral and / or initial

engagement are charted in Figure 28. In half of the cases there were new referrals for

service made.

Figure 28 Referral patterns post CNI and / or initial engagement


For these 21 cases where new referrals arose from the CNI and initial Outcomes Star work,

the range of services to which clients were referred covered the spectrum of service types

from universal services such as primary health and dental work, to secondary services such



37

as family services, through to more specialist services, such as drug and alcohol, and

mental health services.

3.3 Service response levels reflect level of need

Service usage aligns with client need

The extent to which service usage aligns with client need was examined through the case

file review and program data.

Case file review

Figure 29 charts the extent to which the cases identified in the case file review had services

provided that aligned with the Client Support case plan.

Figure 29 Services provided align with the Client Support client plan


Based on the judgment of the lead sites, nearly three quarters of the cases had services

coordinated and accessed that aligned, or broadly aligned, with the Client Support case

plan.

There was greater alignment of services with case plans among Managed Support cases.

The 4 cases where services were deemed not to have aligned with the case plan were all

Guided Support cases.

Figure 30 charts the extent to which the cases identified in the case file review experienced

a ceasing of existing services or referral requests as a result of more coordinated and

targeted case planning.

Figure 30 Extent to which outcomes focussed planning results in the

ceasing of existing services or referral requests


Of the case file review sample, nearly 80 per cent did not experience a ceasing of existing

services or referral requests as a result of more coordinated and targeted case planning. Six

of the eight cases where there was ceasing of services were Managed Support cases.



38

In the cases where lead sites identified services had ceased as a result of outcome

focussed planning the types of services being ceased included:

Disability Services (2 counts)

Housing – SHASP (1 count)

Family Services (1 count)

Child Protection (3 counts)

Budgeting services (1 count).

In 85 per cent of the cases identified, the time spent per week on the case was either the

expected level of service hours or less, indicating that the level of effort required to work with

clients was largely appropriate.

In none of the 42 cases was there a transition between support levels.

Case allocation

To examine the appropriateness of support level allocation, an analysis of average number

of services accessed per case upon entry to Client Support was conducted.

From this analysis there was a higher average number of services accessed for Managed

Support cases than Guided Support at the point of first completed star. Across most

categories the average number was similar, with the biggest difference being in the number

of assessment type services.

Using the average number of cases at first completed star as an indicator of client need

suggests that clients were being correctly allocated to different levels of support when

commencing in Client Support.

As part of Services Connect KPI reporting, the number of active cases per level of support is

recorded monthly. Figure 31 charts the proportion of active cases allocated at Managed and

Guided Support levels between July 2013 and April 2014.

Figure 31 Proportion of active cases allocated to Managed / Guided Support

levels

Source: Services Connect monthly KPI Reports

The proportion of active cases allocated to Guided and Managed Support remained

relatively stable during the identified time period, with approximately 40 per cent of active

cases allocated to Guided Support and 60 per cent to Managed Support.

This has been consistent over the course of most of the past year. This proportion does not

align with the broader Services Connect design and would have implications if the

experience in the testing phase was replicated should the model be expanded in the future.



39

3.4 Services planned and delivered to achieve client

outcomes

Plans clearly articulate an approach to achieve client outcomes

This section includes an assessment of the extent to which service planning clearly

articulated an approach to achieve client outcomes. It examines Client Support and

established program area views on client identified goals and outcomes, and then assesses

both the program data and case file review.

Lead site views on client identified goals and outcomes

Results show that over 80 per cent of Client Support staff considered that clients were

achieving client identified goals and outcomes, while just fewer than 50 per cent of

established program area managers considered this to be the case.

While Client Support staff noted that some clients were still not achieving their outcomes,

they highlighted that most were making progress towards this. Some described that it was

mainly the smaller goals that were being achieved, rather than more significant goals at this

stage.

Team leaders and other staff did express some concern that client identified goals and

outcomes were not appropriate in some cases. Either goals were not being identified by the

clients themselves, rather by the key worker, or they were defined more as outputs rather

than goals or outcomes. For example, team leaders described that ending use of a service,

or booking an appointment with a service is not a client identified goal or outcome — but

rather part of the process.

There were mixed comments from established program area managers regarding the

achievement of client identified goals and outcomes. A number noted that some clients were

at least beginning to achieve individual goals and outcomes, or that they were beginning to

see improvements in outcomes more broadly, such as a greater number of tenancies being

sustained for clients in Client Support.

However, a majority of established program area managers thought that client goals and

outcomes were being achieved to varying degrees, or highlighted that it was hard to tell

whether outcomes were being achieved across the whole model.

Client progress

The Outcomes Star is a case planning tool for cases accessing Guided or Managed levels

of Support. When used with the Motivational Interviewing technique, it is designed to

support client identification of goals, the actions required to achieve those goals, and to

document progress towards those goals.

Outcomes Stars can be conducted and agreed to by the key worker, by the client, or by both

the client and key worker.

To examine the extent of client collaboration in Outcomes Star case planning, analysis of

the Star administrative data was conducted. Figure 32 outlines the extent of client

collaboration in agreeing to the Star. 68 per cent of the Stars recorded were agreed to by

the client and worker, and 25 per cent were agreed by the key worker.



40

Figure 32 Outcomes Star agreement

Source: SC009R Row per Star extracted 23/06/2014

The same dataset was examined to assess whether clients were making progress against

Star ratings.

Figure 33 shows the proportion of clients who have recorded improvement, decline, or no

change against Star outcomes, between completion of their first and last recorded Stars.

For all outcomes across the four different types of Stars, bar one, there was a greater

proportion of improved ratings than proportion of declined ratings.

Teen Stars had the least change and movement across outcomes.

Drug and Alcohol and Offending outcomes on the most widely used Star, the Outcomes

Star, were the most difficult outcomes to affect positive change.

There was considerable positive change across all outcomes, bar the Home and Money

outcome, for the Family Star.

Figure 33 Progress on the Star: Proportion of clients with a change in score against star outcomes

Note: only clients who have had more than a single star have been included. Where multiple stars have been completed, the first and last stars have been used to determine the overall change.

Source: SC009R Row per Star, extracted 23/06/2014



41

Review of Outcomes Stars and Case Plans

The Client Support Model aims to provide an integrated service delivery model that enables

positive engagement with clients and their families and helps them achieve client identified

goals and outcomes. The Outcomes Star and Client Support Case Plan are the case

planning tools with which to identify, plan and monitor achievement of these goals and

outcomes.

As part of the case file review, redacted Outcomes Stars and Case Plans were collected for

each of the 42 identified cases. In total 46 Stars and 62 Case Plans were collected through

the review.

These documents were assessed to determine the extent to which use of the tools

supported collaboration between clients and key workers, clearly articulated client goals that

were outcomes-focussed, and the tasks with which to achieve these goals were clear and

achievable.

Findings below are based on analysis of these documents, and how they have been used

only. Case notes and other supporting information were not accessed. Accordingly, no

judgement of actual client outcomes is made.

Collaboration

As outlined earlier the Outcomes Star is the case planning tool for Client Support.

Similar to the assessment of the Star dataset, analysis of Star collaboration for the case file

review sample was undertaken. This analysis was broadly consistent with earlier program

wide findings. Of the 46 Stars reviewed:

30 of the Stars (65 per cent) had been agreed by both the client and worker

12 of the Stars (26 per cent) had been agreed by just the worker (noting that there can

be circumstances where a star agreed to by just the worker star is the appropriate

approach at that point in time)

For the remaining 4 it was not clear who had agreed the Star.

It was evident from engagement with the lead sites that the Outcomes Star was seen as

pivotal to successfully engaging with clients. Among key workers, Divisional Coordinators

and Practice Consultants there was a consistent view that clients responded well to the

visual element of the tool, that it enabled greater client engagement and ownership, and

represented an approach to working with them that was clearly different to what they had

experienced previously.

Review of the 46 case file review Stars supports these views.

In 33 of the Stars (71 per cent) there was clear evidence across all domains, of client

input and contribution; worker assessment and reflection, and measurement of change

over time (where there had been a previous Star)

In 7 of the Stars (15 per cent) there was less detail, with only minimal amounts of

information that only addressed particular domains.

For the remaining 6 Stars there was no accompanying notes or documentation. These

were mainly Worker agreed Stars. Some of these cases were recent suggesting that a

planning discussion with the client had yet to occur. In one instance, the client had

subsequently disengaged.

Use of the Outcomes Star was supporting collaborative case planning.

Use of the Outcomes Star was also generating interest among other parts of the

Department. In consultation with established program areas, it was clear that there was



42

considerable interest in the Outcomes Star tool and its relevance to clients outside of the

Client Support Model. Senior managers identified it as one component of the Model that

could be used in any broader ‘worker readiness’ initiatives to support future trial efforts.

Client goals

The client plan is a key design feature of the Client Support Model. It is meant to be the one

document that integrates all of the client’s goals and needs identified through the Outcomes

Star engagement. It is outcomes focussed, and clearly articulates the consistent strategies,

actions and responsibilities to achieve identified goals.

The case file review assessed whether the goals, as they are articulated within the client

plan from the sample, were truly outcomes focussed, aspirational, and framed by

capabilities rather than issues, problems or activities. Of the 62 client plans reviewed:

Only 8 client plans (13 per cent) had clearly articulated goals that were aspirational and

clearly aligned to the specific needs of the client

34 of client plans (55 per cent) could be described as articulating partly outcomes-

focussed client goals. They typically contained goals that were a mixture of outcomes-

focussed goals, specific activities, problems and issues

In 20 of the client plans (32 per cent) the plans did not articulate outcomes-focussed

goals. They only listed statements, specific activities, and issues and problems.

The types of activities listed as ‘goals’ included accessing services, such as assessment

and treatment services, and attending appointments with other specialists.

The presence of a statutory order was clearly problematic for key workers in the

development of the client plan. Recognising that there was likely to be a separate case plan

in place because of that order, and that the aim of Client Support is to integrate that

separate order and case plan into the client plan, articulation of the relevant goal was

typically presented within a compliance framework, for example, ‘Abide with obligations of

the Child Protection Supervision Order’ or ‘Complete Youth Justice Order’.

Goals were also being articulated in the client plan as problems or issues, such as ‘address

mental health concerns’ or ‘Housing issues’.

Replication of the Star domain titles was another common feature in the Client Support

Plans, with goals simply stated as ‘Physical Health’, or ‘Managing Money’.

Achieving those goals

The client plans also allow for the documenting of the pathways to which the client will

achieve identified goals. There are a number of different fields available to record tasks, task

details, who the task relates to, people responsible for making the task happen, due dates

for when the task should be completed, and the progress made to date on that task.

Review of the 62 client plans and how they support achievement of client goals is outlined

below.

There were clear descriptions of the task and how it related to the goal in 26 of the client

plans (42 per cent). The descriptions were partly clear in 29 of cases (47 per cent). It

was not clear how the tasks related to the goals in 7 of the cases (11 per cent).

There were clear task details articulated in 29 of the client plans (42 per cent). Tasks

details were partly clear in 13 of the case plans (21 per cent). Task details were not clear

in 20 of the client plans (32 per cent).



43

There was provision in the client plans to detail who separate tasks relate to. This field

was used to identify individuals in 18 of the client plans (29 per cent). In 44 of the client

plans (71 per cent) this field was not being used.

Client plans also allow for nominating which individuals are responsible for actioning the

task. In 27 of the client plans (44 per cent) all tasks had individuals listed as responsible.

In 9 cases (15 per cent) there was some use of this field. In 26 client plans (42 per cent)

there was no use of this part of the plan.

The recording of due dates for task completion is another field on the client plan. In 13 of

the client plans (21 per cent) there was consistent recording of due dates. In 3 client

plans (5 per cent) there was some recording of due dates. In 46 of the client plans (74

per cent) there was no recording of due dates.

Recording of progress is another feature of the client plans. 31 (50 per cent) of the client

plans had recorded progress against tasks and activities. 2 client plans (3 per cent) had

partly recorded progress. It was not clear in 29 of the client plans (47 per cent) if

progress was being recorded.

Use of the client plan appeared problematic.

The extent to which truly outcomes-focussed case planning was being documented and

reflected in the client plans indicates that significant work is required to achieve this

considerable practice change.

Notwithstanding the challenges in articulating outcome-focussed client goals, most client

plans were providing a relatively clear level of detail on tasks to achieve these goals.

However use of the plans beyond that point was generally poor.

There was little or no detail being provided across a range of other aspects of the plan,

including use of the fields that support key elements of the Client Support Model such as

accountability, monitoring and time limited support.

The final point about the case file review sample was the use of two separate client plan

templates. 35 of the client plans used the Client Support Case Plan template. The remaining

27 client plans used the Child and Family Action Plan template.

Acknowledging that the Child and Family Action Plan is designed to be used for cases

where children and young people are part of the plan, there were cases in the sample where

this was not the case, but rather there was a single individual. Use of the Child and Family

Action Plan appeared to be the default plan for two lead sites. Recognising that there is

significant and ongoing work on the ‘One Plan’ element of the Client Support Model, this

degree of variance in the use of a tool fundamental to the concept and design of the Model

was surprising.



44

4 Intermediate benefits

This chapter examines the extent to which the Client Support intermediate benefits were

being realised. This includes analysis of the extent to which the model is resulting in:

More effectively targeted services

Reduced repeat service usage

Reduced service intensity over time.

Reduced number of workers involved in providing support to clients and their families

Reduced duplication of administration and support activities / interactions across

workers

4.1 More effectively targeted services

Human services are targeted and delivered more effectively

More effectively targeting and delivery of services is a key anticipated benefit of the Client

Support Model.

This chapter examines Client Support performance against measures designed to drive time

limited approaches to service provision, Client Support and lead site views on targeting of

services, and references the extent to which client progress is being achieved when

measured against the Star.

Program performance

Median case durations are a Services Connect KPI, designed to monitor and drive the time

limited and targeted aspect of the Client Support Model.

Figure 34 tracks performance against the KPI for active Guided and Managed Support

cases across all five lead trial sites.

Figure 34 Median active case duration for Guided and Managed Support

cases, across all five lead trial sites

Note: *State medians based on medians of Dandenong, Geelong and Southwest only

Source: Services Connect KPI Reports



45

Median case durations for Guided support cases for the three original lead sites have

historically been above the KPI target of 4 months, gradually increasing to October 2013

and was then maintained through to January 2014, but subsequently decreased markedly

when there was a corresponding increase in case closures.

Median case durations for Managed support cases across the program has been tracking

above the KPI target of 6 months, peaking in November in 2013 and was maintained

through to January 2014, but has begun to taper down the closure of more Managed

Support cases since then.

Figure 35 tracks the average case durations for closed Services Connect cases.

Closed Guided Support cases have consistently gone beyond 4 months duration. In 8 out of

10 months of data, Managed Support cases have gone beyond 6 months duration.

Figure 35 Average closed case duration

Source: CRISSP Case Allocations, extracted 28 May 2014

The historical average closed case duration was 6.5 months, which includes a 6.7 month

duration for Managed Support cases, and 6.3 month duration for Guided Support cases.

Both average case durations were above the targets of 4 (Guided Support) and 6 (Managed

Support) months. Implications of a longer than assumed case duration will have cost

implications if replicated in any further trialling of the Model.

However, active case durations presented for the three months prior to review indicated that

case duration was falling back into line with targets. It is important to note that a sharp and

sudden reduction may indicate reasons other than a true duration decrease, for example:

Premature case closure of clients who may not be ready to exit may result in longer term

re-presentation to a service

Sudden increases in data entry to ‘catch up’ on previously un-entered cases may distort

interpretation of trend analysis

Client Support and established program area views

Figure 36 charts the extent to which Client Support staff and established program area

representatives considered that clients were experiencing more targeted support.

Overwhelmingly, Client Support staff believed that clients were experiencing more targeted

support. A majority of established programs agreed with their Client Support colleagues.



46

Figure 36 Extent to which Client Support staff, and representatives from

established program areas consider that clients are experiencing

more targeted support

Source: Client Support Workforce structured questionnaire data; consultation data from 22 established programs across the 5 lead sites

The provision of more targeted support was often described as involving the rationalisation

of services being provided to a client (both from DHS and the community sector) based on

their identified needs, focusing on reducing service duplication, as well as improving the

coordination of those services.

Client Support workers commented that the extent to which more targeted support is

provided to clients can be dependent on the accuracy of the referral and the existence of

statutory orders, where they are in place.

A majority of established program area managers interviewed identified that they were

unable to comment or determine whether clients were receiving more targeted support.

However, some established program areas acknowledged that Client Support was providing

far more targeted support to families, which they simply could not provide through their own

service model, and that they had begun to see positive changes among their clients as a

result.

There was also comment from some program areas that Client Support worked in the same

way as they do, providing holistic and targeted supports to clients, but they had the capacity

to spend more time with their clients to achieve those outcomes.

Client progress

Positive change achieved against Star outcomes can be considered an indicator of

effectively targeted and delivered services. The extent of improvement across the Star was

outlined in Figure 33.

Positive results were observed across most outcomes of three star types, providing an

indicator of at least some degree of effectively targeted services.

4.2 Reduced repeat service usage

Re-presentation rates

Re-presentation rates are commonly used as a quality and performance indicator for human

services.

Re-presentations of clients who have exited Services Connect have been estimated using

DHS services and history linked data to link a client’s unique statistical linkage key to their



47

ongoing service usage in any one of four DHS services; Child Protection, Disability, Housing

or Youth Justice.

Figure 37 shows 9.7 per cent of clients had represented to one of the four programs within 6

months, increasing only marginally to 10.6 per cent when considering those who re-present

within 24 months. 4.7 percent of clients re-presented to Child Protection program after

Services Connect case closure.

Figure 37 Proportion of Services Connect clients who re-present to a

selected programa within cumulative 6-monthly intervals

a Includes four selected DHS program areas, noting data limitations in DHS historical data linkages

Source: DHS services and history linked data extracted 03/06/2014

It is important to note that these Client Support re-presentation rates are not directly

comparable to other program specific data measures, like Child Protection re-reports, for a

number of reasons. Data analysed here is limited by the available timeframes of program

data and the relatively recent period of case closure given that this Services Connect trial is

a new program.

There has been no assessment of the age structure of the Services Connect cohort which

may differ to the Child Protection cohort assessed for re-reporting; older (or different) age

structures may confound the re-presentation rates, as older clients are less likely to access

child protection services, for example.

Nonetheless, this rate of re-presentation to Client Support gives some assurance to the

sustainability of outcomes achieved through Client Support and provides the basis for

potential ongoing monitoring of re-presentation rates of Services Connect clients as more

post-Services Connect time periods and data is accumulated.

4.3 Reduced service intensity over time

Transition to lower levels of support

Service intensity was tested through Client Support and established program area

engagement, and the Progress dataset.

Both Client Support and established program area staff indicated that there was often an

initial increase in services that a client accesses when they began Client Support (due to the

more holistic nature of the support provided), and that at time of review it was too early to

tell whether, overall, service usage was decreasing. The key factors that influenced service

usage were identified as client needs and readiness for change, as well as whether statutory

requirements were in place (often meaning more services were in use). Those clients using

NDIA also usually increased their service usage.



48

However, a number of Client Support staff did identify that there had been better

coordination and an overall simplification of services being provided to clients. In many

cases better coordination of services had reduced service duplication (particularly between

DHS and the community sector).

Client Support staff also described that some clients had reduced their usage of ‘crisis’

services or level of dependency, for example from calling their worker multiple times a day,

to only speaking once a week.

From an established program area perspective, most commented that more work was

needed before any changes in service usage were to be seen.

Some established program area staff commented that momentum had only really been built

in the last nine months, and as such outcomes were only just beginning to emerge. As

identified previously, a number of sites were also only just beginning to see case closures.

The Services Connect Progress data provides a sample of Services Connect cases and has

been used to assess service usage for the available sample of cases held in this data set.

For the purpose of assessing intensity, selected service categories were identified as

intense or non-intense. There is no associated duration or service frequency information to

inform the definition of intensity within the scope of this dataset.

Figure 38 charts the number and proportion of services by intensity, showing that for this

sample of cases there was a much larger decrease (50 percent) in the use of intense

services compared to the non-intense services (21 per cent decrease).

Figure 38 Change in the number of services accessed by intensitya between

completion of first star and exit

a Intense services include Emergency/crisis, Support and Treatment/respite categories, non-intense services include Universal and Early intervention and prevention / capacity building categories


Higher service intensity may also be related to higher support levels. Transitions between

support levels over case transition outlined earlier indicated a higher proportion of cases

were transitioning down from Managed to Guided support than upwards from Guided to

Managed. This confirms the findings presented above indicating that Client Support

Services Connect cases were beginning to experience reduced levels of service intensity.



49

4.4 Reduced number of workers

Human services accessed by the client cohort

The experience for many clients of DHS delivered or funded services, is of multiple services,

and workers.

The Services Connect Progress data tool collects data on services, as well as whether the

worker associated with the service is on the care team, which allows for assessment of the

number of workers engaged with a client.

Analysis of this data shows that at completion of the first star, on average 2 to 3 workers

were on the care team of Guided Support cases and just over 4 workers were working on

Managed Support cases, with an average of 3.4 workers on the care team across both

support levels.

This appeared to decrease through case progression, but interpretation of this change over

time should be made with considerable caution as the number of cases that had recorded

intermediate reviews decreased markedly. It is important to note that workers on the care

team at exit was largely non-existent, suggesting considerable data entry and quality issues.

The case file review also allowed for an assessment of DHS and NGO workers involved with

clients at different points in time. This dataset indicated that overall the number of DHS staff

reduced from 25 workers to 19 workers, with reductions in the numbers of Child Protection

practitioners and Housing officers over the duration of these cases.

The number of NGO workers increased from 25 workers to 32 workers over the case

duration. These workers were typically associated with universal and preventative services

(though not always).

Reduced number of crisis and support human services accessed

An anticipated benefit of increased service coordination is for more integrated and efficient

use of services.

The Services Connect Progress data has been used to assess service usage for the

available sample of cases held in this data set.

Figure 39 shows that among the closed cases with a linked data record between completion

of first Star and exit from Client Support, half of the cases showed a decrease in the number

of crisis and support type services. The other half of cases either experienced an increase in

these types of services, or no change. It is important to note the limitations of the data, with

the sample of complete records (with linked records between first Star and exit points) in the

Progress dataset representing less than 40 per cent of the 395 Services Connect closed

cases to date. Accordingly interpretation should be made with caution.



50

Figure 39 Proportion of services connect casesa that had a reported

decrease in the number of emergency / crisis and servicesb from

completion of first star to exit

a includes only those cases with an first star and exit record (158 cases identified) b includes Emergency/crisis, Support and Treatment/respite categories


Figure 40 charts the total number of services per case, showing the level of services

decreased slightly between first star and exit points.

Figure 40 Number of services accessed at completion of first star and at exit

from client support, by specialist service category

Note: includes only those cases with both a first star and exit record (148 cases identified)


Significantly there were increases in the use of universal services, and noticeable decreases

in Emergency / crisis and Support service categories.



51

5 Barriers to be resolved

This review identified a number of barriers to be resolved for successful trialling of the Client

Support Model. These comprise:

Design barriers

Barriers associated with introducing changes in services

These barriers are discussed in further detail below, along with key considerations for how

they may be resolved.

In outlining these barriers it is important to note that ongoing work to further develop or

improve the model is underway. Where such work is underway it is cited underneath the

identified barrier.

5.1 Design barriers

Design barriers listed here are considered fundamental to any scaling up of Client Support.

The identified barriers include:

Alignment with statutory services

Absence of an integrated intake

Performance monitoring of Client Support outcomes

Ownership of Client Support Key Performance Indicators

Alignment with statutory services

Examination of Services Connect documentation and discussions with a wide range of DHS

staff, including senior management and staff within Client Support, failed to identify how

clients with multiple and complex needs, and / or long term statutory orders that extend

beyond the four and six month durations of Guided and Managed Support are to be

accommodated within the Services Connect Model.

This lack of certainty extends to clients who are or may in the future access NDIA, or for

clients with a level of complexity that precludes them from Managed Support but that is not

severe enough to be considered for the Multiple and Complex Needs Initiative (MACNI).

There appears to be an unresolved conflict between two design elements of the Model, one

being the time-limited nature of the Model and the other being the desire for a single,

primary contact point between the client and human services system over time – the ‘one

worker’ aspect of the Model. The absence of clear entry and exit points into Client Support

for the type of clients who may not need ongoing case allocation but will be long term clients

of DHS was another complicating factor.

The review found widely varying interpretations among the lead sites of how this conflict

should be resolved. Some staff were of the view that clients with statutory orders exceeding

6 months were not suitable to transfer to Client Support (and never would be).

Most sites have established Child Protection and Youth Justice Liaison officers for Client

Support, who maintain statutory delegation for clients with statutory orders (one site has

transferred statutory delegations for Youth Justice to Client Support). This approach accepts

that the key worker will only be the primary point of contact for the client for a limited period,

after which contact will revert to the relevant established program area.



52

However the review found the lack of clarity regarding management of clients with statutory

orders under the Model was restricting referrals to Client Support from statutory areas of

DHS and that it was unclear whether this was the intended response. If it was not the

intended response, clarity on management of the design conflict – particularly in relation to

delegation and where it should sit - is required. This includes engagement with external

stakeholders such as the Children’s Court to ensure they are informed about the approach

and are comfortable working with it.

Conversely, it should be made clear to all staff and clients if the intention is that clients with

statutory orders exceeding 6 months not be included in Client Support.

The other design issue that relates to the other case carrying programs of the Department is

the prescribed caseloads for Client Support. Recognising that the caseload is designed to

facilitate more intensive case work (albeit for a shorter duration of time) it is unclear how

sustainable this caseload will be if the model is expanded and encompasses more of the

activity of DHS.

Design work underway

Analysis of current delegations within statutory services has been undertaken.

Work on the appropriateness of the 4 to 6 month duration for Guided and Managed Support

is underway. This includes examination of supporting the improvement of tools like the CNI

to better support assessment by need rather than by statutory order.

Absence of an integrated Intake

Internal testing of Client Support has relied on referrals from existing DHS established

program areas.

As canvassed in this report, testing of Client Support led to some clients who were too

complex, or not ready for Client Support, coming over with new key workers. Conversely,

the lack of clarity among initial lead sites led to some highly prescriptive approaches to client

identification that prevented referral of potential clients to Client Support.

These experiences conditioned established program area views of Client Support,

particularly among the initial sites, and (in conjunction with the alignment to statutory

services barrier) continued to impact on referral patterns from parts of DHS.

Over time establishment of Client Support in the lead sites has begun to drive a degree of

internal service integration within IFS branches (comprising Housing, Disability and Youth

Justice).

Across some IFS branches, there were examples of integrated intake and referral pathways

that have been developed for clients who first present to transition directly to Client Support

(if deemed appropriate). Given the lower than expected numbers of Guided Support cases,

this development is likely to be a particularly important enabler to identifying appropriate

clients for Guided Support.

Establishing a more integrated intake – at a local level – will also support future expansion

of the Model into the community sector and should be pursued across the program more

broadly.


Further work on the CNI and identification of Guided Support clients is underway.



53

Performance monitoring of Client Support outcomes

Good data drives policy design and provides monitoring and assurance that program

priorities and objectives are being met.

The input of data into Client Support data collection systems was highly varied. There was

duplication of data input across multiple data collection systems. Inconsistency in the

completeness, accuracy and quality of data was particularly the case for the Services

Connect Progress dataset. The design of the data collection tool has complicated collection

and analysis of data. Data elements to be collected were viewed and interpreted differently

by users.

Fundamentally, the Progress dataset in its form and use at the time of review did not provide

adequate monitoring and assurance of Services Connect outcomes measures, and will not

support future reporting against a yet to be established Services Connect Outcomes

Framework.

In the form at time of review, key data barriers to be resolved within Progress include:

Quality and completion issues resulting in significant limitations to accurate analysis and

interpretation of information

Inconsistency within and between different data sets meaning that potential integration

of information sourced from multiple areas was difficult; the ability to leverage multiple

sources though linkage and integration can provide huge efficiencies and benefits to the

information that can be generated, potentially reducing the need for multiple collection

tools and associated impost of duplicated data input effort

Different levels or categories of services existing in different sources - Progress provides

an exhaustive set of services beyond that available in individual CRIS and other

sources, but meaningful analysis requires an element of standard classification. Ideally,

categorisation into levels that are consistent with other sources would provide additional

benefits of integration.

Definitional and user documentation, and potentially ongoing user training, would assist both

workers responsible for data input and users of the collected data, and/or re-configuration of

the structure and wording of problematic data elements (discussed in further detail in

Appendix B).

Ownership of Client Support Key Performance Indicators

KPIs drive practice and behaviour change.

The median case duration may or may not be the appropriate KPI to drive time limited

service responses for the Client Support Model. However, the KPI was not viewed

favourably by the Client Support workforce. There was some discussion in lead sites about

the appropriateness of some client transitions out of Client Support that reportedly were

determined by length of time considerations.

If the KPI remains there needs to be consideration as to how the link between the KPI, client

outcomes and service excellence can be made transparent to the workforce, and something

to strive for, rather than merely comply with.


Services Connect KPIs were being revised at the time of this review.



54

5.2 Barriers arising from introducing service

change

The identified barriers arising from introducing service change include:

Navigating multiple IT platforms


Recruiting the right skills, capabilities and capacity to commence in Client Support

Workforce readiness for practice change

Linking operational intelligence with policy design

Sequencing establishment within new lead sites

These barriers are likely to have an ongoing impact on current lead sites but also on any

potential sector trial or new DHS lead sites.

Navigating multiple IT platforms

Client Support staff in lead sites have found the means to access and share the client and

service information they need to deliver the Model. This has been achieved through a

mixture of local factors that include: pre-existing relationships across established program

areas, co-location of staff, and using the access rights of other Client Support staff.

Notwithstanding these local adaptations and strategies it is unclear how sustainable they

would be should the Client Support Model be expanded.

Acknowledging that a single IT client record is already part of the planned future system

architecture of Services Connect, it is not yet clear when or if this element of the Model will

be introduced. Given the recent announcement of new lead sites and sector trials there will

be a tipping point when establishment of an integrated IT client system becomes a

necessity.


Scoping of policy and privacy considerations and compatibility is underway.

Development of a new interim Services Connect IT platform has commenced, and will be

tested in DHS lead sites and sector trials.


Testing of the Client Support Model requires careful balancing of prescription, in the

interests of consistency, and freedom to enable local innovation and adaptation.

At the time of this review, there was monitoring of elements of the Model, like timely

completion of Outcomes Stars, where there was impressive program performance.

However there were also core components of the Model and the tools to support the Model

that were not being applied consistently or in line with the Model’s design.

Across the Client Support workforce there was a strong desire for consistency, and for key

workers to have confidence that the work they do sits securely within an authorised

framework.

The extent to which staff identified with the release of revised operational guidelines and the

latest version of the Practice Framework affirmed the importance of strong and consistent

guidance on the fundamental aspects of the Model where fidelity to certain approaches and

principles was needed if the program is to deliver the benefits it is designed to achieve.



55

The review found evidence that:

The CNI tool was not valued by established and Client Support staff. 40 per cent of the

cases sampled through the case file review did not have a CNI

The use of Client Support Case Plans did not accord with the client-driven and

outcomes-based objectives of the model. Use at the time of review did not support

accountability, transparency and client ownership

Care team meetings did not appear to be embedded in case practice (noting that they

are not a mandated feature of case practice).

While a degree of variation should be expected and welcomed across parts of the Model

during this test period, key worker ambivalence or adherence to these tools and approaches

is likely to continue in the absence of more consistent advice and emphasis on their

importance.


Review and development of tools including the CNI and One Plan is underway.

Recruiting the right skills, capabilities and capacity to commence in Client

Support

The Client Support Model requires workers to practice in a new way and work across a

number of complex service areas. As such, consideration needs to be given to the skill,

experience required by staff to work in Client Support, and a willingness to work in new

ways.

This consideration is particularly important in light of the recent decision on the role of the

Practice Consultant.

In recruiting from existing staff in DHS, there has been a wide range of skills and experience

levels brought into Client Support. The review found that having representation from each

established program area in Client Support teams was a key strength of the Model.

However, in discussion with Client Support staff and senior Area management, it was clear

that the Practice Consultant role has provided a considerable degree of practice guidance

and support for staff new to Client Support, and quality assurance to service provision. The

role’s absence should be factored into any local decision making on future recruitment.

Clearer career development and pathways should be considered for more inexperienced

staff in established program areas, including how current training and development may up-

skill them for potential work within a more holistic and outcomes-based Model.

Consideration should be given to encouraging diverse and multidisciplinary skill mixes for

Client Support teams in any new trial sites and sector trials. Given the importance of

information sharing across program areas and sectors, it may be appropriate to release

advanced DHS staff to sector trial sites in either an advisory or team leader role. The model

of the Child FIRST Community Based Child Protection Worker could serve as an example of

a co-located worker who either sits within the community sector Client Support Team or at

least facilitates appropriate communication and coordination between community based

services and specialist DHS delivered services (where required).

Workforce readiness for practice change

The Client Support Model represents a dramatic shift in the way services are delivered by

DHS.



56

To date, it has taken significant time and investment to generate an understanding and

acceptance of the Client Support Model across DHS, and particularly among established

program staff.

In a number of sites, the review found that much of the success of the Client Support was

dependent on individuals and staff relationships between program areas. In considering

further trial sites it is critical to build this understanding among DHS staff at a broad level, as

well as within the established program areas that frequently interact with the Client Support

program.

In order to build this broader understanding of the Model, there may be opportunities to

encourage testing of Client Support practice (including client driven planning, or holistic

support) and practice tools (including Outcomes Star and Motivational Interviewing

techniques) within established program areas.

This approach has potential for beginning to generate a significant shift in mindset and

practice within DHS, towards a more client-driven and outcomes based approach to

delivering support, and bringing the Department to a greater state of Services Connect work

readiness.

Awareness raising and relationship development should continue to occur both internally

with established program areas, and across the broader community sector to build

understanding of the Model. This should be targeted beyond those community sector

organisations that are considered for the sector trials.

A clear need was identified for continued training, development and practice support for

staff. Many staff recognised the significant time it has taken them to develop the skills

required to deliver all components of the Client Support Model and achieve the change in

practice needed to support client driven outcomes. Key workers identified a need to revisit

and extend upon a number of existing training areas (e.g. Motivational Interviewing). This

was primarily because so much training was delivered in the early stages of testing, and

many found it difficult to incorporate all learnings into practice.

There was also reason to pursue how Client Support practice tools could be adapted to

better engage CALD clients or clients of Aboriginal or Torres Strait Islander background.

Linking operational intelligence with policy design

There was a clear message from Client Support and Area staff, at varying levels, on the

adequacy of feedback mechanisms to Central Office and the capacity for operational

intelligence to be fed back into policy and program design and shared more broadly across

the Department and lead sites.

This was particularly the case for the sharing of learnings and processes used between

sites. Operational staff had an appetite for how the Model was being trialled in other sites

and felt that they were missing opportunities to discuss challenges and options for

improvement. While key workers appreciated the opportunity provided by the key worker

forum they would like to have had more control of its operation and agenda.

Given the strength of this feeling among five sites, it is likely this attitude to Central Office –

unfair or otherwise – will persist.

Sequencing establishment within lead sites

As Client Support becomes more firmly embedded in the lead sites it should be aiming for a

steady and balanced inflow and outflow of clients, to ensure Client Support staff are well

utilised but also to avoid peaks and troughs.



57

In engaging with the lead sites, there were a number of descriptions and accounts of early

frenetic activity to find clients, or ‘drumming up business’ which quickly led to full case-loads

with clients all at similar stages in their trajectory.

This created a scenario of initially accepting large numbers of clients, then refusing new

referrals as the teams were at capacity. This was followed 4 to 6 months later with a lull in

casework as those initial cases were closed. The risk is that this lull then generated a new

cycle of ‘case-finding’. It was reported that this scenario was currently playing out in one of

the two more recent lead sites.

While it is understandable that take up of full caseloads will be encouraged, lead site

commencement is the most appropriate time for a staged approach to case transition and

onboarding of both staff and clients, and for establishing consistency in case inflows and

subsequent outflows, and ensures that staff have a balance of new cases, established

cases and cases transitioning to closures at any one time.


Based on the experiences of the initial sites, recent and planned lead sites have had a more

staged scale up period when commencing.



A-1

Appendix A Evaluation framework

A.1 Evaluation design

This evaluation was designed to assess the extent to which enabling changes were in place,

project outcomes were being achieved and anticipated intermediate benefits were being

realised.

The evaluation design was informed by engagement and consultation with members of the

Department of Human Services’ Centre for Human Research and Evaluation, and the

Services Connect Design and Implementation Team, review of policy and program

documentation, and examination of relevant data sets.

A.2 Evaluation framework

Table A1 maps the enabling changes required for successful trialling of Client Support, to

the required descriptive and measurement data, data requirements and performance

measures, and where this data is sourced.



A-2

Table A1 Measuring the extent to which enabling changes have been introduced, as originally designed

Descriptive data Measurement data Data required / performance measure Data source

ENABLING CHANGE - Appropriate clients for client support model identified and transitioned

Description of the Client Support Model client cohort

Client Support cohort characteristics since trial commencement, including length of previous DHS involvement

Complexity of the Client Support cohort compared with the broader DHS client cohort using length of previous DHS involvement as to inform the counterfactual.


Common Client Index

Description of interface between Client Support and established program areas in the lead site

Current Client Identification, Access, and transition to Client Support processes

Local enablers and barriers to client identification, access and transition


Appropriate clients referred to Client Support from established program areas

Proportion of clients referred to Services Connect that are appropriate for the trial Case file review


Key Worker provided with adequate client information from established program area at time of referral

Proportion of Key Workers who perceive they receive adequate client information from established program areas at time of referral

Client Support questionnaire


Timely first contact between Key Worker and client Time elapsed between client being referred to Client Support and first contact between Key Worker and client

Case file review


ENABLING CHANGE - Client support model introduced at lead sites with appropriate staff and training put in place

Description of the Services Connect Client Support Model workforce

Client Support Model workforce, by qualification, and established program area background DHS HR dataset

Description of Client Support workforce

development and support activity including practice guidance and support

Central Office strategies to support recruitment, training / learning and development activity and attendance

Local Area strategies to support recruitment, training / learning and development activity

Central office program documentation


Client Support service staffing positions are filled with appropriate staff

Proportion of Services Connect positions filled at points in time (establishment and current)

Time that Services Connect positions are vacant DHS HR dataset

ENABLING CHANGE - Client support model introduced at lead sites with appropriate staff and training put in place (continued)

Client Support staff are appropriately skilled

Proportion of Services Connect staff who report they are appropriately skilled to deliver the key components of Client Support

Proportion of Services Connect staff who perceive they are adequately trained

Proportion of staff in established program areas who perceive Services Connect Client Support staff are adequately skilled



Extent to which Key Workers have the practice guidance and supervision they need to deliver Client Support

Proportion of Services Connect staff who report they receive the practice guidance and support they need to deliver key elements of Client Support



ENABLING CHANGE - Key workers provided with sufficient information to coordinate services

Description of planning and coordination processes in the lead site

Current processes to planning and coordination of services through Client Support

Local enablers and barriers to the planning and coordination of services through Client Support



Interface between Client Support and established program areas supports information sharing and service coordination

Proportion of Key Workers and established program area staff who are able to access client information as required

Percentage of Key Workers and established program area staff who share client information as required





A-3


Key Workers have sufficient information about services that are available for clients

Proportion of Key Workers who report they have sufficient knowledge of services available for clients to develop holistic plans for clients



ENABLING CHANGE - Outcomes-based client driven planning introduced as part of client support model

Description of the extent to which the Client Support cohort transitions between managed and guided support, to case closure

Extent of movement between managed and guided levels of support over case duration Services Connect Database (CRISSP)

Description of client engagement and participation processes in the lead site

Local enablers and barriers to enabling client driven outcomes Lead site interviews

Client driven planning underpins Client Support practice

Proportion of cases with a Plan and Outcomes Star in place within KPI timelines

Proportion of Client Support Key Workers who report they support client driven planning

Services Connect Database (CRISSP)

Case file review

Client Support Questionnaire

Source: ACIL Allen Consulting 2014 Evaluation of the Client Support Model lead site trial – Evaluation Framework

Table A2 maps project outcomes expected to be achieved through trialling of Client Support, to the required measurement data, data requirements and performance measures, and where

this data is sourced.

Table A2 Measuring the extent to which project outcomes are being achieved

Measurement data Data required / performance measure Data source

PROJECT OUTCOME - Clients allocated a single Key Worker and have an integrated service plan

Clients are allocated one key worker who acts as the primary contact between the client and the service system

Proportion of Client Support cases where clients are engaging with fewer workers than they were before transition to Client Support.

Case file review



Clients have a single integrated case plan

Proportion of Client Support cases with a single client plan (capture number of client records for each client)

Proportion of Client Support Key Workers who report that all service delivery staff involved in a case, work from one single case plan

Common Client Index

Case file review



PROJECT OUTCOME - Holistic support provided to clients based on comprehensive assessment of needs

Clients experience one comprehensive assessment of need Proportion of cases with a CNI

Average number of needs identified at entry



Case file review

Clients are experiencing holistic support

Proportion of cases with multiple needs and / or client plans at time of transition to Client Support

Proportion of cases with multiple needs and / or client plans at time of exit from Client Support

Proportion of case plans that articulate actions that clearly respond to key needs identified through the CNI


Case file review



A-4

Measurement data Data required / performance measure Data source

PROJECT OUTCOME - Client allocated to service response level reflecting their level of need

Service usage aligns with client need

Proportion of services provided as per the case plan

Proportion of cases allocated to manage/guided support levels

Average number of specialist services accessed per client by level and service category



Case file review


PROJECT OUTCOME - Services are planned and delivered to achieve specified client outcomes

Plans clearly articulate an approach to achieve client outcomes Proportion of clients making progress on Outcomes Star

Proportion of cases where case plans clearly articulate goals, and the tasks to which to achieve those goals


Case file review


Table A3 maps intermediate benefits expected to realised through successful trialling of Client Support, to the required descriptive and measurement data, areas for focus, data

requirements and performance measures, and where this data is sourced. Importantly the extent to which project outcomes identified in Table 2 have been achieved will inform the

measurement of intermediate benefits.

Table A3 Measuring the extent to which intermediate benefits have been realised


INTERMEDIATE BENEFIT – Reduced number of workers involved in providing support to clients and their families

Description of number of human services accessed by Victorian clients and their families

Aggregate of human services accessed by DHS client cohort to inform the counterfactual.

NGO survey and Common Client Index

There is a reduced number of crisis and support human services accessed by Client Support clients

Decrease in number of crisis and support human services accessed by Client Support cohort - per capita and aggregate

(quantified by data measuring project outcomes, and established program area views, tested through the counterfactual under a business as usual scenario of cohort in established program areas)

Lead site interviews (Area Directors and established program areas)



Common Client Index

Case file review

There is a reduced cost of human services associated with services accessed by Client Support clients

Decrease in estimated cost of human services accessed by Client Support cohort – per capita and aggregate




Case file review



A-5


INTERMEDIATE BENEFIT – Reduced duplication of administration and support activities / interactions across workers

Description of volume and cost of administration and support activities involved with providing support to clients and their families

Aggregate cost of activity associated with the Client Support cohort under a business as usual scenario to inform the counterfactual

There is a reduction in cost of administrative and support activities

Decrease in the volume and cost of access / identify / plan activities performed – per capita and aggregate


Lead site interviews (Area Directors and established program areas)


Case file review

INTERMEDIATE BENEFIT – More effectively targeted services

Human services are targeted more effectively

Median / average case duration and intensity for Managed and Guided support clients

Proportion of cases appropriately allocated to managed and guided support levels based on complexity of need



Case file review

Human services are delivered more effectively Proportion of cases where there has been an improvement achieved against Client Outcomes Star within KPI guidelines


Case file review

INTERMEDIATE BENEFIT – Reduced repeat service usage

Re-presentation rates to the human services and Client Support Service System

Number (and proportion) of clients who re-present to a service within 6 month intervals of Client Support case closure, including type of service for which they have re-presented

Common Client Index


INTERMEDIATE BENEFIT – Reduced service intensity over time

Clients are successfully transitioned to a lower level of support, or exited from Client Support

Number (and proportion) of cases where there has been a reduction in the level of intensity of services within Client Support

Number (and proportion) of cases where there has been a reduction in the use of specialist services



Case file review




B-1

Appendix B Data strategy, sources and definitions

B.1 Overview

The quantitative data strategy applied for the purpose of this evaluation is covered in the Evaluation Framework, involving

three main components; assessment of data availability and quality, extraction/collection and validation, and analysis.

The following sections describe the administrative data sources utilised, and statements regarding the quality and

associated data definitions.

B.2 Administrative data

Administrative data collected by the Department and utilised for this evaluation are summarised in Table B1.

Table B1 Administrative data sources

Data set / report Source data Description Timeframe

SC007R Services Connect Case Allocations

DHS Client Relationship Information System for Service Providers (CRISSP) database

This report displays Services Connect case allocations with a worker role of ‘Primary Assigned’ (referred to as ‘primary case allocations’), including related case and client information.

This provides a complete number of Services Connect cases across trial sites to date.

All Services Connect cases to end of April 2014.

Provided by DHS 13 May 2014

SC009R Services Connect Row Per Star

DHS CRISSP database

DHS Outcomes Star database

This report displays Services Connect star outcome scores and associated client information. The information sourced from two databases is mapped through the CRISSP Client ID.

Note: This report was recently modified to include all four star types (previously included two) upon ACIL Allen’s request.

All Services Connect cases to date of extract.

Provided by DHS 23 June 2014

SC014 - Plans, Goals and Tasks Report

DHS CRISSP database This report provides details of all Plans, Goals and Tasks created in the CRISSP system for Services Connect.

Note: data from this report was analysed but has not been presented in this evaluation.

All Services Connect cases to end of April 2014

Services Connect Progress Dataset

DHS web based data collection tool for Services Connect

Further details provided in Table xx below. Access database table format provided by DHS 2 June 2014

Services Connect monthly KPI reports

Routine monthly reporting of established Services Connect Key Performance Indicators.

Monthly reports from July 2013 to April 2014.

Provided by DHS 17 April 2014

DHS services and history linked data

DHS program sources:

Child Protection (CP) - from Client Relationship Information System (CRIS)

Housing - from CRIS

Disability - from the Disability National Minimum Dataset (NMDS)

Youth Justice (YJ) - from Housing Integrated Information Program (HiiP)

Specialised linked data request for clients of Services Connect closed cases identified to April 2014, based on statistical linkage methods using a Statistical Linkage Key (SLK)581.

This data consists of a total of 582 SLKs (or clients), 21 of which are duplicated with overlapping Services Connect events. It is difficult to determine whether these duplicates are repeat services, or whether the clients forms part of another case. Duplicates have therefore been included in analysis.

Data sources are limited to the following timeframes:

CP – all historical data held to end of May 2014

Housing Jan 2008 – May 2014

Disability – all historical data held to end of Dec 2013

YJ – annual financial year data 2002/03 – 2012/13

Linkage performed by the Modelling & Forecasting Team, Centre for Human Services Research and Evaluation.

Data provided 4 June 2014

Source: ACIL Allen Consulting, 2014

Table B2 provides a summary of ACIL Allen’s experience with data quality of the Services Connect Progress Dataset. As we

understand, this is a relatively new data collection tool and no such data quality documentation already exists. This table is

not intended be an official data quality statement for this collection, it simply summarises our findings regarding data quality

for the purposes of appropriate interpretation of analysis for this evaluation.



B-2

Table B2 Services Connect Progress Dataset - data quality statement

Area Statement

Key points

Description

Web based collection tool designed specifically for Services Connect to collect information on:

the areas of need that clients enter client support with

the services they are already accessing when they enter

the services that are identified as needed

the services they access

the services they are unable to access

the areas they achieve outcomes in throughout the life of their client support intervention

Data is collected from completion of the first star throughout case progression to exit from Services Connect.

Data source Data is submitted via the web based collection tool by key or other nominated workers

Relevance

Our understanding is this dataset was primarily designed to collect and provide information on Services Connect functions and outcomes, the front end design of which is relatively user friendly as a data entry tool. However meaningful analysis is difficult due to the current system design, particularly analysis of trend or utilisation data over time. Currently, an accurate picture of current activity in Services Connect is limited by accuracy issues (discussed further below).

Timeliness Our understanding is data is collected in real time upon submission; however, there is no process for data validation so data availability is subject to quality issues identified elsewhere in this table.

Accuracy

Completeness issues of data collected exists at two main levels: Services Connect case information that has not been entered into the system at all and incomplete data entries.

Consistency and accuracy of Progress data with other data sources – limited checks have been performed by ACIL Allen in the process of this evaluation, revealing the following inconsistencies with other data sources:

430 cases recorded in Progress, representing 58% of the 743 total cases identified in the SC007R Services Connect Case Allocations report (73% with an active status, 45% with a closed status)

Progress recorded cases as a proportion of total cases by site:

Dandenong 60%

Southwest Coast 43%

Geelong 46%

North East 63%

Goulburn 81%

There were 175 cases with an exit record in Progress, representing 44% of 395 total closed cases identified in the SC007R Services Connect Case Allocations report; however, 32 (9%) of these Progress cases had an Active status in SC007R. It is not known which source provides the more accurate status.

12 cases’ first record was an exit record, and

5 Progress records contained clientIDs in the caseID field; these records were excluded from analysis as matching records in other tables via caseID was not achievable

Definition of ‘client’ is inconsistent; for example, needs at entry is requested for the client with highest level of need, subsequent progress points define client as a person who has a task relating to them in the Client Support Plan

No routine internal validation is performed on Progress data elements collected. Therefore, analysis is subject to inherent and potentially unknown quality issues.

A small sample of case file reviews were compared to the data collected in Progress. Initial comparative assessment revealed that many cases recoded a greater number of needs and services than those picked up in the case file reviews. However, the majority of types of needs and services identified in case files were also entered in Progress. Resource and time limitations did not allow assessment of a sample of case files for cases not captured in Progress. To gain a more accurate understanding of the accuracy and completeness of the Progress data tool, a more thorough audit would need to be conducted.



B-3

Area Statement

Coherence

Workers and plans

As we understand, issues have been identified regarding workers’ differing interpretation of several questions, which will result in inconsistencies in the recording of client information, though differences in data entered or missing data due to misinterpretation. Examples include:

Other plan in use – often interpreted as whether the plan has been sighted

At various progress points, service status at least progress point (or 3 months prior at entry) as well as current status is required. It appears services are replicated in bulk in some cases, making meaningful analysis of service progress inaccurate

In addition, as new workers come on board over time, adequate training in the use of the Progress tool has not continued, which may result in inconsistency in use of and/or information entered (if at all).

Services

Service information is available in three separate fields:

Category – consisting of 13 main service categories:

Aged care

Disability

Drug and alcohol

Education training learning and

Housing

Living skills

Managing trauma

Mental health and emotional well

Money

Offending

Parenting family services and ca

Physical health

Social and cultural connection

Activity or Type associated with each category, of which there are currently 151 available for selection

Other description – a free text field to describe the Service/Activity/Type if a selected option is not already available

To the date of this extracted Progress dataset, client data consists of 404 different service combinations of the above three service elements. To enable meaningful analysis and identification of specialist services, data has been aggregated into 8 service categories:

Universal

Assessment

Early intervention and prevention / capacity building

Emergency / crisis

Support

Treatment / respite

Long term

Other

Table B3 outlines the assigned categorisation for each Service category and associated activity and type within the Services Connect Progress Dataset and applied to this evaluation.

Accessibility

Data collected centrally is available to selected DHS units for assessing the activity and impact of Services Connect trial to date.

It is our understanding that key and other workers responsible for submitting the data are not able to access or review the collected data at this point.

The format of the Progress data is difficult to navigate, requiring significant cleaning and recoding to enable useful analysis.

Interpretability

Field definitions have not been documented to date. Analysis based purely on a field name is open to users’ interpretation.

Impact of incompleteness and quality issues (discussed above) may be significant. Therefore, results presented in this evaluation should be interpreted with caution.

Source: ACIL Allen Consulting, June 2014



B-4

Table B3 outlines the assigned categorisation for each Service category and associated activity and type within

the Services Connect Progress Dataset.

The eight agreed categories comprised:

Universal

Assessment

Early intervention and prevention / capacity building

Emergency / crisis

Support

Treatment / respite

Long term

Other

Each Progress service category activity and type with the Progress Dataset was categorised into these eight

categories based on consultation and agreement with the Centre for Human Services Research and Evaluation

and representatives from relevant DHS program areas.

Table B3 Service Categorisation – Progress Dataset

Progress Service category Associated Progress Activity or Type Assigned service category

Aged care

ACAS assessment Assessment

Admission to a residential aged care service Universal

Allied health - e.g. physio Universal

Carer support - aged care Early intervention and prevention / capacity building

Community health service Early intervention and prevention / capacity building

Home and Community Care Early intervention and prevention / capacity building

Meals program Universal

Other Other

Disability

Advocacy Early intervention and prevention / capacity building

Aids and equipment Support

Allied health and behavioural interventions Support

Behavioural modification and management - inc. BIST Support

Carer support - disability Early intervention and prevention / capacity building

Case management - disability Support

Day program - disability Support

Facilitation Support

Independent living training - disability Support

Individual support packages Support

Other Other

Plan of service tied to a disability justice order Emergency/Crisis

Public trustee Support

Rehabilitation Support

Respite - Residential Treatment / respite

Respite - community based Treatment / respite

Shared supported accommodation - SSA Support

Supported residential care - disability Support

Target Group Assessment Assessment

Transport service for people with disabilities Support



B-5


Drug and alcohol

Aboriginal AOD support Support

Alcohol and drug supported accommodation Emergency/Crisis

Ante and post natal support Treatment / respite

Counselling Treatment / respite

Day program Treatment / respite

Non-residential withdrawal Treatment / respite

Other Other

Outreach Treatment / respite

Peer support Early intervention and prevention / capacity building

Pharmacotherapy Treatment / respite

Private alcohol and drug service Early intervention and prevention / capacity building

Residential rehabilitation Support

Residential withdrawal Support

Education training learning and employment

Child care Universal

Community service to help with education expenses Early intervention and prevention / capacity building

Disability day activity Early intervention and prevention / capacity building

Education services for people with disabilities Early intervention and prevention / capacity building

Employment job placement and support Early intervention and prevention / capacity building

Further education & training - ie adult Universal

Further education and training Universal

Home based education Universal

Other other

Pre-school Universal

Primary school Universal

School counsellor or psychologist Universal

Secondary school Universal

Skills development Universal

Supported employment Early intervention and prevention / capacity building

Transport - related to education Universal

Volunteer program Universal

Work and learning centre Early intervention and prevention / capacity building

Housing

Advocacy or support to access housing Support

Advocacy or support to sustain tenancy - non-financial Support

Homelessness service - crisis Emergency/Crisis

Homelessness service - transitional Support

Other Other

Private rental access Early intervention and prevention / capacity building

Public Housing Long term

Refuge or hostel Emergency/Crisis

Residential rehabilitation or recovery service Treatment / respite

Social Housing Early intervention and prevention / capacity building

Supported Housing - disability Early intervention and prevention / capacity building

Supported Housing - leaving care Early intervention and prevention / capacity building

Supported Housing - mental health Long term

Supported Housing - other Long term

Supported Housing - youth justice Early intervention and prevention / capacity building

Supported residential service - SRS Long term

Youth accom - not through Supported Housing Early intervention and prevention / capacity building



B-6


Living skills

Advocacy and referral service Support

Communication skills service Early intervention and prevention / capacity building

Community group or peer support Early intervention and prevention / capacity building

Home and Community Care - HACC Early intervention and prevention / capacity building

House maintenance service Early intervention and prevention / capacity building

Independent living training Early intervention and prevention / capacity building

Interpreter or translation service Universal

Meals program Universal

Mentoring program Early intervention and prevention / capacity building

Neighbourhood houses Universal

Other other

Skills training and practice program Early intervention and prevention / capacity building

Managing trauma

Family violence support and advocacy Emergency/Crisis

Other Other

Refugee and asylum seeker support service Support

Sexual assault service Support

Trauma based counselling Support

Mental health and emotional wellbeing

Adult Mental Health Service - community Early intervention and prevention / capacity building

Adult Mental Health Service - inpatient Treatment / respite

Aged Mental Health Service - community Early intervention and prevention / capacity building

Child and Youth Mental Health Service - community Early intervention and prevention / capacity building

Community Health Service Early intervention and prevention / capacity building

GP-referred psychological services Universal

Other other

PDRSS - community Support

Private mental health service Universal

Specialist clinical mental health service Early intervention and prevention / capacity building

Money

Centrelink Universal

Concessions Universal

Consolidation of fines Universal

Emergency relief Emergency/Crisis

Financial assistance to sustain accommodation Emergency/Crisis

Financial counsellor Universal

Food provision Emergency/Crisis

Household goods clothing and furniture Emergency/Crisis

Other Other

Offending

Case management - court Support

Court advice and advocacy e.g. CISP ARC Drug Court Support

Disability forensic assessment and treatment service Assessment

Exiting prison support Support

Legal aid Universal

Mental health - forensic Treatment / respite

Other Other

Police Emergency/Crisis



B-7


Parenting family services and care for children

Adoption service Universal

Antenatal care Universal

Child care Universal

Child protection Emergency/Crisis

Counselling for parenting family and caring Early intervention and prevention / capacity building

Family services Support

Family violence support and advocacy service Support

Maternal and child health Universal

Men's behaviour change Support

Other Other

Other counselling Early intervention and prevention / capacity building

Out of home care Support

Parenting program Support

Refugee minor program Support

Respite support Early intervention and prevention / capacity building

Physical health

Alternative healthcare Universal

Audiology Universal

Care Coordination Universal

Carer support - physical health Early intervention and prevention / capacity building

Chronic pain management Universal

Counselling or Casework Support

Diabetes self-management Universal

Dietetics Universal

Family Planning Universal

General practitioner Universal

Hospital Services: emergency; inpatient; outpatient; surgery Emergency/Crisis

Initial Needs Identification Assessment

Integrated Chronic Disease Management Early intervention and prevention / capacity building

Nursing Universal

Occupational Therapy Universal

Optical Universal

Other Other

Paediatrics Universal

Physiotherapy Universal

Podiatry Universal

Speech Therapy Universal

Social and cultural connection

Community education Universal

Cultural connection - eg. community group Universal

Migrant centre Universal

Neighbourhood house Universal

Other Other

Religious organisation Universal

Social club Universal

Sporting Clubs Universal

Transport service to access cultural and social programs Early intervention and prevention / capacity building

Source: ACIL Allen Consulting, in consultation with the Centre for Human Services Research and Evaluation and representatives from relevant DHS program areas

B.3 Key measure definitions

This section provides an overview of definitions of key measures drawn from administrative data, including data

inclusions/exclusions and quality statements where applicable.



B-8

Table B4 Key measure definitions

Measure Definition

ENABLING CHANGE - Outcomes-based client driven planning introduced as part of client support model

Proportion of case transitions between managed and guided levels of support over case duration

(Figure 20)

Data source SC007R Services Connect Case Allocations

Exclusion criteria

CaseIDs identified for exclusion by CRISSP counting rules:

… Cases with zero duration

… Cases transitioning between support levels counted only once

… North East cases closed prior to 1 October 2013

… NDIS cases

Cases with a single allocation record to date (i.e. no progress transitions)

Outcome (numerator)

Expressed as a proportion at each progress point, number of cases identified with transition levels as follows:

Improved – managed to guided

No change

Declined – guided to managed

By starting support level

Quality issues Number of clients with intermediate progress points is limited; interpretation of transition proportions for these points should be made with caution.

PROJECT OUTCOME - Holistic support provided to clients based on comprehensive assessment of needs

Average number of needs identified at entry

(Figure 27)

Data source Progress

Exclusion criteria

CaseIDs identified for exclusion by relevant CRISSP case counting rules

Cases with clientIDs entered as CaseIDs

Needs with Level=No Need

Outcome (numerator)

Average number of needs per case by

Level (Low, Medium, High)

Main reason for seeking assistance (Yes/No)

Quality issues Interpretation of main need may be inconsistent

PROJECT OUTCOME - Services planned and delivered to achieve client outcomes

Proportion of clients with a change in score against star outcomes

(Figure 33)

Data source SC009R Services Connect Row Per Star

Exclusion criteria

Clients with single star records (i.e. only clients with a first star and at least one subsequent star assessed for changes in scores)

Where clients have multiple star records, only the first and last start are included for a score change, transitional starts are excluded for this purpose.

Outcome (numerator)

Expressed as a proportion of total clients included - number of clients identified with levels of change in the following categories:

Improved – score increased

No change

Declined – score decreased

Quality issues

Star agreement

(Figure 32)

Data source SC009R Services Connect Row Per Star

Exclusion criteria None

Outcome (numerator)

Proportion of all client stars by Who agreed the star categories:

Client

Client & worker

Worker

Unknown

Quality issues

INTERMEDIATE BENEFIT – Reduced number of workers involved in providing support to clients and their families

Proportion of services connect cases(a) that had a reported decrease in the number of services from completion of first star to exit (Figure 39)


Exclusion criteria


Cases with ClientIDs entered as CaseIDs

Cases without both a first star and exit record

Services deemed to be inactive (i.e. Status = “No longer needed”, “No longer active” or “Has been used but is no longer active”)

Outcome (numerator)

Number of services where Worker on care team = Yes

Average - the mean number of services with a worker on the care team, by support level and specialist service categories.

Quality issues Approximately 56% of services contained missing worker on care team data.



B-9

Measure Definition

Number of specialist services (Figure 40,


Exclusion criteria


Cases with ClientIDs entered as CaseIDs

Cases without both a first star and exit record

Services deemed to be inactive (i.e. Status = “No longer needed”, “No longer active” or “Has been used but is no longer active”)

Outcome (numerator) Number of specialist services identified at progress points, by support level and specialist service category

Quality issues

22 cases at first completed star have all services flagged as being used in the 3 months prior to first contact – may be an interpretation issue upon data entry

Exit records do not have a support level recorded at exit; where presented by support level exits have been assumed to have the last recorded support level

INTERMEDIATE BENEFIT – Reduced repeat service usage

Proportion of services connect clients who re-present to a selected program within cumulative 6-monthly intervals

Data source DHS services and history linked data

Exclusion criteria None

Outcome (numerator)

Re-presentations are identified as program event start dates are within 6 monthly intervals of the SLK’s services connect event end date.

Presented as a proportion of total SLKs

Quality issues

Services Connect is a relatively new program, there is therefore limited timeframe post services connect from which to identify re-presentations.

DHS program data is limited by the timeframes available (refer to Table B1) for each and therefore does not capture all possible re-presentations to date.

The age of a client may be associated with the rate at which he/she may re-present to a selected service. For example, older clients are not as likely to access Child Protection program as younger ones. The age structure in services connect clients has not been examined here. Therefore comparison to other published or known re-presentation rates should be made with caution.

Source: ACIL Allen Consulting, June 2014

B.4 Case file review

Sampling approach

The sampling approach applied to case file selection for review is detailed in the Evaluation Framework. The broad

approach involved stratification of cases into the five sites (strata) and application of a systematic random sampling

approach within each stratum. There have been a total of 743 services connect cases up to April 2014, the individual site

numbers of which are displayed in Table B5.

Given the time and capacity constraints of this evaluation, the sample was deliberately limited so as to be achievable in the

project timeframes. Sample size estimates for each of the 5 stratum are provided in Table B5. These were determined

based on a simple random sampling approach for the population size of each site (or stratum) identified in Table B5, and

assumptions of:

95% confidence level (level of certainty with which the true population value will be estimated)

Expected proportion of the desired attribute of 0.5 (provides the most conservative sample estimate)

Confidence interval of 0.32-0.38 for each stratum (level of accuracy of the estimate)

Table B5 Services Connect case and sample numbers by site

Lead sites

Dandenong Geelong Shepparton Warrnambool Preston TOTAL

Cases 243 179 93 82 146 743

Sample 10 9 7 7 9 42

Note: Case counting rules have been applied to exclude relevant cases (refer to Table B1). Assumptions - 95% Confidence Level, estimated confidence interval of 0.32-0.38, expected attribute proportion of 0.5 (most conservative approach)

Source: SC007R Case Allocations Report from 1/2/2012-1/5/2014, extracted 13/05/2014



B-10

It is important to note that these sample sizes and associated reliability estimates are estimates only and may be adjusted

based on a number of considerations, such as:

Expected attribute proportion will not be 0.5 for all measures, therefore reliability will differ depending on the nature and

purpose of the measure to be informed by this sample data

Relative importance of strata and case characteristics

A further modification to sample case file selection was applied to limit the case population by periods in which cases

commenced to allow more established client support processes to be reviewed, as follows:

1 January 2013 to 31 January 2014 for Dandenong, Geelong and Southwest

1 November 2013 to 31 January 2014 for Goulburn and North East

It is important to note from a sampling method perspective, this would have the effect of reducing both the base population

from which samples are drawn and the associated confidence intervals. It also means that analysis of results is reflective of

the modified case population rather than the entire services connect trial population from inception.

Extraction of the sample

Case file review templates were distributed to each of the lead sites, to enable consistent case file review data collection and

analysis. The template was designed in an Excel macro for ease of use and to ensure consistency in responses.

Hard copies of redacted Outcomes Stars, CNIs and Client Support case plans were also extracted.

A tabulated version of the Excel macro is provided at Table B6.



B-11

Table B6 Case review template

Review questions Responses

Case ID

Lead Site

Name of person completing the template

Date of referral to Client Support

Client CRISSP ID

Were there statutory orders in place for the primary client at time of referral? None

Child Protection

Youth Justice

Corrections

Ward of the Commonwealth

Mental Health Treatment Plan

NDIA

If multiple orders are in palace, please specific here

Length and type of DHS involvement by established program area at time of referral (expressed as years of involvement)

No history One year

Two years Three years

Four years Five years or more

Number of family members included in the case at: Referral: Review: Closure:

Are there other members of the client’s family with a history of DHS involvement?

Yes If yes, please specify No

Client Support Level at referral Managed Guided

Date of allocation to a Key Worker

Date of first contact between client and Key Worker

Was CNI conversation (discussion of strengths and needs) conducted and recorded? Yes No

Date that CNI form was completed

Needs and strengths identified

Did engagement of the client during CNI or Outcomes Star work, result in new referrals to specialist service(s) (as a result of identifying a particular need)?

Yes If yes, to which service(s)?

No

Number and type of programs and service types at time of: Referral: Review: Closure:

Number of and type of DHS workers at time of: Referral: Review: Closure:

Number and type of community sector / NGO workers at time of Referral: Review: Closure:

Number of client plans (excluding Client Support Plan) at time of: Referral: Review: Closure:

If there is more than one client plan, is it evident that it is integrated with the Client Support Plan? At:

Referral: Review: Closure:

Did outcomes focussed planning result in the ceasing of some existing services or referral requests? (please specify)

How regularly does the Care Team meet?

Is it evident from the file that the Key Worker chairs the Care Team? Yes No

Is it evident from the file that the Key Worker is taking on the client support activities arising from the Care Team meetings?

Yes No

On average, how many hours of service per week have been provided for this case?

Equivalent to expected level of support for Guided (2 hours per week) or Managed (3 hours per week)

More than expected (quantify)

Less than expected (quantify)

Do services accessed by the client align with the case plan? Yes Broadly No

At review or exit, is the client more involved in work, education, learning or community activities than they were at time of referral?

Yes (nominate types of involvement)

No

Has the client exited Client Support, or transitioned from Managed to Guided Support?

Exited Client Support

Remains at the same level that they commenced

Transitioned from Managed to Guided

Transitioned from Guided to Managed



C-1

Appendix C Stakeholder engagement

C.1 Lead site engagement

Engagement with each of the lead sites occurred between 15 and 30 May. In total 41 consultations and 45 Client Support

workforce structured interviews (including 7 Team Leaders and 38 Key Workers) were conducted across the lead sites.

All of the Client Support workforce interviews were done face-to-face. Interviews were mostly conducted onsite at each lead

site, with some phone and video conferencing also occurring.

The breakdown of consultations across each lead site is outlined in Table C1.

Table C1 Engagement with the lead sites

Dandenong

(Southern Melbourne)

Geelong

(Barwon)

Warrnambool

(Western District Area)

Shepparton

(Goulburn)

Preston

(North East Melbourne)

Interviews with Area Management and Services Connect project testing and oversight

Former Area Director Area Director Area Director Area Director Area Director

Acting Individual and Family Support Manager

Assistant Director, Individual

& Family Support

Acting Individual and Family Support Manager

Individual and Family Support Manager

Services Connect Manager

Acting South Division Services Connect Project Coordinator

Individual and Family Support Client Services Manager

West Division Services Connect Practice Consultant

East Division Services Connect Project Coordinator

North Division Services Connect Project Coordinator

South Division Services Connect Practice Consultant

West Division Services Connect Project Coordinator

East Division Services Connect Practice Consultant

North Division Services Connect Practice Consultant

Client Support workforce structured interviews

Client Support teams (2 Team Leaders and 14 Key Workers)


Client Support team (4 Key Workers)

Client Support team (1 Team Leader and 6 Key Workers)


Interviews with established program areas

Refugee Minors Program Team Manager

Child Protection Area Manager, Practice Leader, and Team Manager

Disability Accommodation Team Manager

Youth Justice Team Manager

Child Protection Team Manager, and Services Connect liaison

Disability Services Team Manager

Child Protection Operations Manager

Disability Case Management Team Manager

Disability Client Services Team Manager

Youth Justice Team Manager, and Youth Justice practitioner

Housing Manager and Team Manager (Tenancy)

Youth Justice and Local Connections Managers


Housing Team Managers (Tenancy and Housing Advice and Assistance Team

A/Manager Disability Client Services

Child Protection Area Manager

IFS Case Management Team Leader (Disability)

Child Protection Team Manager

Child Protection Services Connect Liaison

Housing Manager


Child Protection Services Connect Liaison

Housing Team Managers (Tenancy and Housing Advice and Assistance)



C-2

C.1.1 Tabulated Questionnaire results

The structured questionnaire was conducted face-to-face with Client Support staff in each of the lead sites.

Team Leaders and key workers were interviewed. Where staff had only commenced in the past six months, the questions that

asked for a response over two points only focussed on the previous 3 months.

Data provided includes response count and overall percentage. Key themes from qualitative data is also provided where

appropriate.

Respondent characteristics

Number of responses by position

Respondents by position Number of respondents Per cent

Client support team leader 7 16%

Managed support key worker 18 40%

Guided support key worker 16 36%

Other key worker (carried a mixture of cases) 4 8%

Total 45 100%

Length of employment within client support

Length of employment within client support, number of staff

Less than 6 months 6 months to 1 year 1 year + 2 years +

Total 12 17 14 2

Previous area of employment

Previous area of employment

Child protection Disability Youth Justice Housing RMP Community Sector

Total 12 9 8 10 1 4

Total (Per cent) 28% 20% 18% 23% 2% 9%

Identification and transition of clients

Question 1. I receive adequate information from established program areas at the time of referral of clients, to support their transition into Client Support

Strongly agree Agree Neither agree nor

disagree Disagree Strongly disagree Total

All sites 5 23 9 6 2 45

11% 51% 20% 13% 5% 100%

Question 2. After transition to Client Support, I am the main point of contact between my clients and the broader human services system

Strongly agree Agree Neither agree nor

disagree Disagree Strongly disagree

Total

All sites 15 25 4 1 0 45

33% 56% 9% 2% 0% 100%



C-3

Question 3. Reflecting on your time in the role, what has had the biggest impact on how clients are identified, referred and transitioned to Client

Support?

Number of respondents

(identified as the most important) Feedback themes

Growing awareness of Client Support across established program areas

27 Growing trust between Client Support and established program areas

Improved communication and engagement

Introduction of the CNI tool 4 Issues with the tool and how it is used

Introduction of the Practice Guidelines 2 Supports consistency

Other / comments field 12 All equally important

The Outcomes Star

Confidence

Recruitment, training, learning and development

Recruitment to Client Support roles

Question 4. When I commenced in Client Support I felt I was appropriately skilled to take up my role

Strongly agree Agree

Neither agree nor disagree

Disagree Strongly disagree Total

All sites 8 23 6 7 1 45

18% 51% 13% 16% 2% 100%

Training, Learning and Development, Support

Question 5. The induction training I received gave me the skills I needed to commence working within the Client Support service




All sites 11 20 2 10 2 45

25% 45% 4% 22% 4% 100%

Question 6. Ongoing learning and development opportunities have given me the skills I need to deliver outcomes based, client driven planning


Neither agree nor

disagree Disagree Strongly disagree

Total

All sites 11 27 1 5 1 45

25% 60% 2% 11% 2% 100%

Question 7. I now have the skills needed to deliver all of the key components of the Client Support service




All sites 9 24 6 4 2 45

20% 53% 13% 9% 5% 100%

Question 8. I receive the practice guidance and support I need to successfully deliver the Client Support Model




All sites 16 21 3 5 0 45

35% 47% 7% 11% 0% 100%



C-4

Coordination of services

Local human services system

Question 9. I have sufficient information about the local human services system to develop holistic plans with clients




All sites 9 28 4 3 0 44

20% 64% 9% 7% 0% 100%

Coordination of services

Question 10. I have a comprehensive understanding of my client’s needs




All sites 20 23 1 1 0 45

45% 51% 2% 2% 0% 100%

Question 11. I have a good understanding of any statutory obligations that are relevant to my clients




All sites 10 24 8 3 0 45

22% 53% 18% 7% 0% 100%

Question 12. I am able to access and share client information when I need it




All sites 6 32 3 4 0 45

13% 71% 7% 9% 0% 100%

Question 13. My clients have a single case plan that allows me to coordinate the full range of supports and services they need




All sites

7 23 5 7 2 44

16% 52% 11% 16% 5% 100%

Operational infrastructure to support the Client Support Model

Question 14. There is a single client record for each of my clients




All sites 2 6 4 26 6 44

4% 14% 9% 59% 14% 100%

Question 15. How many client records do your clients have? Summary of responses

Significant variability. On average between 2 to 3



C-5

Practice guidance and support

Question 16. Reflecting on your time in the role, which of the following do you see as critical to further supporting you to coordinate services in line

with the Client Support Model?

Number of responses

(identified as most important)

Feedback themes

Awareness and engagement at the interface between Client Support and established program areas

13 Central to the overall success of the Model

Consistency of practice across the Area 9

Importance of Client Support and established program areas working towards shared goals

There is inconsistency of practice between Client Support teams

Regular access to supervision and secondary consultation 7 Team Leader role is critical

Consistency in application of various practice tools 2 Ongoing challenge for new key workers

IT and other operational infrastructure 14

Impacts on workloads

Prevents good information sharing across different program areas

Other / comments field All considered equally important

Outcomes based client driven planning

Practice change

Question 17. As part of the Client Support service, clients experience client driven planning




All sites 15 24 5 1 0 45

33.5% 53.5% 11% 2% 0% 100%

Question 18. Thinking of your current active case load, are your clients experiencing the following:

Yes No Total Summary of responses – If no, why?

More targeted support? 43 1 44 Dependent on quality and accuracy of the referral

98% 2% 100%

Less workers or case managers involved in their life? 35 10 45 Clients can be linked into more services and more workers when they start in Client Support

Statutory services still require case managers to be involved 78% 22% 100%

Achievement of client identified goals and outcomes? 38 7 45 Building the relationship with clients takes time

Can depend on client capacity and willingness to engage 84% 16% 100%

A reduction in service usage? 22 20 42 In some cases, but difficult to tell at this early stage

Clients often experience an increase of services when they commence in Client Support 52% 48% 100%



C-6

Support to drive practice change

Question 19. I have the tools needed to enable outcomes based, client driven planning




All sites 14 28 2 1 0 45

31% 62% 5% 2% 0% 100%

Question 20. I feel supported and prepared for client driven planning




All sites 14 26 3 2 0 45

31% 58% 7% 4% 0% 100%

Question 21. I am collaborating with my clients to achieve sustainable outcomes in way that I didn’t previously




All sites 12 22 3 6 1 44

27% 50% 7% 14% 2% 100%

Question 22. Reflecting on your time in the role, what do you consider fundamental to supporting you to achieve practice change?

Number of responses

(identified as most important)

Feedback themes

Awareness and engagement at the interface between Client Support and established program areas

12 Dependent on the extent to which established program areas accept Client Support

Training and development opportunities 13

Valued by key workers

More support, training and certainty about the Model would be welcomed

Greater consistency in practice through the use of standardised tools

11 Key workers aware of inconsistencies across and within sites

Regular access to supervision and secondary consultation 9

Valued by key workers

Seen as one of the key enablers to sustaining practice change

Other / comments field

All considered equally important

Motivational Interviewing and improved communication about changes to the Model also identified

ACIL ALLEN CONSULTING PTY LTD

ABN 68 102 652 148

LEVEL FIFTEEN

127 CREEK STREET

BRISBANE QLD 4000

AUSTRALIA

T+61 7 3009 8700

F+61 7 3009 8799

LEVEL TWO

33 AINSLIE PLACE

CANBERRA ACT 2600

AUSTRALIA

T+61 2 6103 8200

F+61 2 6103 8233

LEVEL NINE

60 COLLINS STREET

MELBOURNE VIC 3000

AUSTRALIA

T+61 3 8650 6000

F+61 3 9654 6363

LEVEL ONE

50 PITT STREET

SYDNEY NSW 2000

AUSTRALIA

T+61 2 8272 5100

F+61 2 9247 2455

SUITE C2 CENTA BUILDING

118 RAILWAY STREET

WEST PERTH WA 6005

AUSTRALIA

T+61 8 9449 9600

F+61 8 9322 3955

ACILALLEN.COM.AU

services connect: review of the client support model lead ... · acil allen consulting iii list of...

Documents