“Reunification The Stakes Are High”

1. “ReunificationThe Stakes Are High” CatholicCare Sydney Diocese 2010

2. CatholicCare’s Values & Beliefs. • The values and beliefs underlying CatholicCare’s multi suite of family services reflect the main tenets of Catholic Social Teachings, in particular the notion that: • “ no relationship is more central than the family” • The profound importance of family connections are life-long, and as such the State and all other institutions have a responsibility to respect, foster and protect families.

3. CatholicCare’s Restoration Service.within our“Placement, Preservation & Restoration” Program ( PPR ) • Was developed in 1987 to meet the need for an intensive specialist service that would embark on permanency planning for child/ren in care in the most effective, comprehensive and expedient manner possible. • It provides an intensive service model for parent/s with a child who is currently in out-of-home care and where there is either a Community Services (DoCS) endorsed plan or Children’s Court order for the parent to resume care of the child/ren. • It provides a service that can accurately and compassionately determine the best permanent placement for a particular child in a non-protracted way.

4. CatholicCare’s Restoration Service cont. • CatholicCare’s restoration service has worked with numerous unique families over the many years since receiving initial funding and has developed a large bank of practice wisdom to draw on in relation to what is helpful and unhelpful for families who are working toward a reunification between parents and their children. It has been gratifying to conduct a review of the current research to find that this practise wisdom matches empirical findings both internationally and in Australia.

5. CatholicCare’s Restoration Service cont. • It is a service that is able to engage parents and children early in their entry in to the child-protection system in an assessment of viability for restoration, and the restoration plan itself. • It is a service that is able to provide a comprehensive and holistic assessment which focuses on all aspects of family functioning including both strengths and concerns, is child focused - identifying their needs and the parents capacity to respond • It is a service that works in partnership with parents, children, extended family, Community Services and other services in a collaborative and respectful manner.

6. CatholicCare’s Restoration Service cont. • It places high priority to maintaining the parent-child relationship during the child’s time in placement, through contact and is able to utilise this time to work on parent-child bonding and attachment and parenting skills • It concentrates on the physical, intellectual and emotional aspects of a parent’s ability to provide adequate care for children over time, and • It is a service able to offer intensive, family centred assistance with much work being carried out in the family’s home.

7. The Safety of the Child is Paramount. • The effectiveness of how we assess a child’s needs and a parent’s capacity to respond to their child’s needs is the key to the effectiveness of subsequent intervention service plans and ultimately, the outcomes for the child.

8. Working for change is most effective when done in partnership. • Working in partnership with the families invites responsibility and builds hope for the future. • To recognise and value client skills and strengths and to harness these in order to work toward positive change, is critical in the process of client engagement. • A collaborative partnership encourages services, families and the community to work together to learn from each other in garnering the best outcomes for children.

9. Child Centred / Child Inclusive. • Each child’s development is significantly shaped by his or her particular experiences and the interaction between a number of factors. • The child must be ‘seen’ and kept in focus of a parent / family assessment process -to clearly identify and understand the impact of their family and community circumstances on their development and how their identified needs can be met. • In accordance with the child’s developmental capabilities we must engage them to actively participate in the decision-making that will affect their lives.

10. All people have the potential to change. • Current research shows that focussing on people’s strengths and skills is more successful in sustaining long term change than being saturated in the deficits. • ‘In the strengths approach, every interaction is based on principles of social justice, respect, transparency, self-determination, the sharing of resources, skills and knowledge and a recognition of people’s own strengths and resources. ‘Beyond Child Rescue, St Lukes‘

11. “Signs of Safety.” • A Strength Based approach provides a structure that encourages people with a shared vision for a child’s wellbeing to work together, adding value to what each can provide, fostering hope and motivation for change. • However the issues that bring a family to the attention of Community Services must not be dismissed but rather considered in the context of an informed appraisal of the resources and strengths – ‘signs of safety’ for a family. These can often be mobilised to safeguard and promote a child’s welfare.

12. Valuing Diversity. • It is important to be respectful of the beliefs, values, culture, religion and lifestyle of our clients whilst working toward change. • Goals and changes to be addressed should be focussed only on issues pertaining to the child’s safety and the ongoing capacity of the parent to care, as opposed to factors that may not fit a traditional stereotype or societal norm regarding how a family should look or operate.

13. PermanencyPlanning. • It is best for children to be cared for within their own families wherever it is safe and viable • However in cases where it is not safe or viable for this to occur, permanency planning should be implemented in a timely manner in order to reduce the hurt, loss and grief experienced by the child through multiple separations from important attachments.

14. So Why A Restoration Viability Assessment ? • The need to assess the viability of restoration and for a clear and well-formulated plan to meet the goals of restoration is of crucial importance in all cases of children entering the care system (Barber & Gilbertson, 2001). • The Children’s Guardian guidelines clearly caution against breaks in the continuity of care for a child due to temporary and unsuccessful returns home.

15. Phases of Restoration Service Model. • Referral and Intake – through Community Services CSC’s ( Metro SW and Metro Central ) • Viability Assessment ( engagement and assessment of Parenting capacity ) • Restoration Transition Plan ( transfer of attachments ) • Program Intervention ( Goals of intervention to improve parenting capacity to meet the needs of the child/ ren – child & family focused) • Preservation ( to sustain positive changes )

16. Timeframes at a Glance “of sufficient intensity & duration to support & sustain positive change “ 1__________2__________3__________4__________5 Engagement & Referral Assessment Transition / Program Preservation Intake 8 -10 wks 3 – 6 months 3 months

17. Referral & Intake. • Only accepted from Community Services where an intensive service is considered essential for the parent to meet the necessary standards of care to safely resume care of their child. • In line with the research supporting permanency planning commencing in an expedient manner after removal, referral for assessment is preferably at point of removal of the child.

18. Engagement. • As a voluntary service parents have provided consent to willingly engage in work with an experienced specialist caseworker on the goals they need to achieve in order to safely resume care of their child on a permanent basis. • This necessarily requires that the parent will have or can develop some insight and sense of responsibility into the reasons behind their child/ren being removed from their care.

19. Assessment. ( 8-10 weeks including full report ) • On a psychodynamiclevel, the caseworker invests time speaking with the client about their history, their own experience of being parented, and their relationship, attachment and ability to empathise with their child/ren. • On a practicallevel, the caseworker spends time observing the client’s ability to manage everyday parenting and life skills, maintain stability of housing, finances and other minimal duties of care. • Additionally, the caseworker would facilitate the client’s identification of the aspects of parenting they are currently managing well, in addition to their daily stressors and possible triggers for increased levels of anxiety, drug and alcohol misuse, mental health decline and so on.

20. Our Licensed Assessment Tool.NCFAS-R • CatholicCare obtained a licence to use the North Carolina Family Assessment Scale for Reunification (NCFAS – R). • The purpose of the NCFAS – R is to further enhance the ability of the restoration caseworker to provide Community Services with an accurate and comprehensive evaluation of the client’s strengths, skills, challenges and concerns, as well as provide a measure of change achieved by the client over their time in the program. • The NCFAS – R is an evidence-based assessment instrument intended to assist case practitioners using intensive family preservation service strategies to effect successful reunifications of families where children have been removed following substantiated abuse and or neglect.

21. NCFAS-R cont. • The NCFAS-R provides family functioning assessment ratings on the following seven domains relevant to the reunification effort; Environment, Parental Capabilities, Family Interactions, Family Safety, Child Well-Being, Caregiver/Child Ambivalence, and Readiness for Reunification. • The NCFAS – R scale ratings have been shown a statistically significant positive association with successful reunification and a significant negative association with post-reunification placement breakdown (Kirk, 2002).

22. NCFAS-R cont. • Assessment ratings are obtained at Intake and again at Case Closure. • Intake ratings are for the purposes of case planning. • Closure ratings are used to document the status of the family at the end of the restoration process, and are also used as the basis of recommendations, possible service referrals and for post-intensive service planning. • Change scores (the difference between the Intake and Closure ratings) quantify the level of shift undertaken by the client/s during the intensive reunification service period.

23. NCFAS-R Domains & Ratings.Clear stgth Mild stgthBaseline adequate Mild problem Mod problem Serious problem • Environment • Parental Capabilities • Family Interactions • Family Safety • Child Well-Being • Child / carer Ambivalence • Readiness for Reunification

24. Environment. • Housing stability • Safety in the community • Habitability of housing • Income / employment • Financial management • Food & nutrition • Personal hygiene • Transportation • Learning environment

25. Parental Capabilities. • Supervision of children • Disciplinary practises • Provision of developmental / enrichment opportunities • Parent/s / caregiver’s mental health • “ “ physical health • “ “ use of drugs / alcohol

26. Family Interactions. • Bonding with children • Expectations of the children • Mutual support within the family • Relationship between the parents / caregivers

27. Family Safety. • Absence / presence of Physical abuse of children • “ “ Sexual abuse of children • “ “ Emotional abuse of children • “ “ Neglect of children • “ “ DV between parents / caregivers

28. Child Well-Being. • Children’s mental health • Children’s behaviour • School performance • Relationship with parents / caregivers • Relationship with siblings • Relationship with peers • Cooperation / motivation to maintain the family

29. Child / Carer Ambivalence. • Parent / caregiver ambivalence towards child • Child ambivalence towards parent /caregiver • Ambivalence provided by substitute caregiver • Disrupted attachment • Re-Unification Home Visitation

30. Readiness for Reunification • Resolution of significant risk factors • Completion of case service plans • Resolution of legal issues • Parent / caregiver understanding of child treatment needs

31. How is the information gathered? • Direct work with the child • Direct work with the parents • Direct work with the family/ significant others • Direct work with the child and current caregivers, • Observation, of the child alone and of the child/parent(s)/caregiver(s) interaction. • Other sources of knowledge, including those who have known the child over time, such as the midwife, health visitor, general practitioner, nursery staff or school teachers, • Other information held on files and records and from previous assessments. These should always be carefully checked as far as possible. • Specialist assessments from a range of professionals who have been involved with the child / family to provide specific understanding about an aspect of the child’s development, parental strengths and difficulties or the family’s functioning. Eg educational psychologists, speech therapists, early intervention services. The timing of these and their particular contribution to the analysis of the child’s needs and the plan of intervention will require careful consideration.

32. When Restoration is Recommended. • Where to from here?

33. Restoration Transition. • Critical to successful reunifications is ensuring a transition plan is carefully considered with regard to all key stakeholders but most importantly keeping the child central to the process. • A well developed transition plan must consider developmentally age appropriate strategies that will assist the transference of the primary care relationship of the carer to the parent / new carer. • And it must support the parent to maintain consistent care routines already familiar & established for the child.

34. Restoration Transition & Program Intervention. • Caseworker provides an intensive support service once the family commences restoration transition & program phase. • Caseworker will develop and implement a Transition Plan • Continued support is provided to the family to work on goals of intervention identified throughout assessment phase and thereafter. ( Individual Service Plan ) • Caseworker will assist the family to access any other appropriate and necessary services which can support the family in an ongoing way once the restoration service has ceased their involvement.

35. Transitioning from Restoration to Preservation. • As an extension to the work undertaken in the Restoration Program, the caseworker has the capacity to continue supporting families for a further three months. • Although some families will exit the Restoration Program with sufficient evidence to show they have effected changes to support ‘good enough parenting’ and have adequate community wrap-around support services in place, other families still require further and often intensive support. • Families requiring additional time to meet agreed goals of intervention to maximise their opportunities to sustain positive change in the best interest of their children’s safety and wellbeing will be offered and provided this opportunity through the natural transition to the Preservation Program.

36. What we know works. • Limited case loads -Caseworkers should not have more than three to four cases at any one time (Miller 2006) • Effective case management systems- This allows a coordinated approach to service delivery. ( 4 -6 wkly reviews ) • Staff must be available to give sufficient intensity and duration of service support in flexible ways especially in the assessment phase and early stages of transition / program intervention – modelling and training in the home at different times throughout a day. • Knowledge and access to wrap- around support services to allow families to be weaned off the intensive support when they are ready to cope more independently.

37. Case Study: Initial Service Plan.develop from NCFAS-R Assessment • See attached – full ISP Case Study

38. Some stats for July 2009 – June 2010

39. July 2009 –June 2010 Stats for Restoration • 3 families brought fwd to continue program ( all successfully restored and have sustained permanency ) Average intervention period = 8 months • 34 new referrals ( 50% SW Sydney & 50% Metro Central ) • 28/ 34 eligible meeting program criteria • 16 /28 ( 57% )engaged with service according to referral service entry point ( assessment- 13, transition - 3 ) • 6/28 withdrew referrals subsequent to being put on waiting list with the following outcomes ( 21.5% ) 1. Prolonged waiting list time resulted in other support services being engaged = 1 2. Re-referred at later date for Restoration = 1 3. Re- referred at later date for Preservation program = 1 4. Increased risk issues resulted in Long term care plans being sought = 2 5. Alternative restoration placement option = 1 • A further 6/28 currently remain on waiting list ( 21.5% )

40. Outcomes for 19 families / 33 children

41. When permanency outcomes are not yet known- “My Kids and Me” • Catholicare’s 7 week parenting program ‘My Kids and Me,’ provides an opportunity for parents whose children are in care to understand the importance of how they can foster & maintain healthy relationships with their children. • Even when restoration is not possible, a valuable outcome occurs when many parents are able to utilize the process of restoration to achieve a greater level of resolution about the reasons they are unable to care for their child/ren full-time .

42. Preservation - NCFAS • The Preservation Program is a discrete service within the PPR program. • Families identified by Community Services who are at imminent risk of their children being removed are referred to CatholicCare’s PPR program. • Alternatively families where a child has been recently restored by Community Services and where an intensive support service to sustain the placement is required. • These families are also provided with an intensive service model approach, using the related assessment tool, NCFAS

43. In the same reporting period Preservation Program • 20 Referrals • 6/20 allocated ( 30% ) • 2 – now closed, positive changes in domains, linked with relevant wrap around services to sustain permanency, average intervention timeframe 7.5 months • 3 – still ongoing at 4 months of intervention • 1 – closed, after heightened risk issues identified during assessment, now pending court order for Long term placement • 12/20 – declined / withdrawn, no program capacity or did not meet criteria

44. Thank you for your participation! • For further information about the Restoration and or Preservation programs provided by CatholicCare, PPR Program please do not hesitate to contact me. Jacquie Leabeater Manager PPR Program Ph: 02 8709 9333 Mobile: 0417 6888 10 Email: jacquie.leabeater@catholiccare.org Or visit our website for all CatholicCare program information. www.catholiccare.org

45. Case Study • Transition – using ‘contact visits’ The parent for restoration (natural mother) had had very little time parenting her younger son who was 2 years old at the time. He in fact viewed his maternal grandmother as his primary attachment figure, as she had cared for him since he was approximately 8 months old. CatholicCare utilised several strategies to ensure quality contact that would serve to transfer and strengthen the attachment between mother and child. One of the successful strategies implemented - to support the mother to attend the “Mums and Bubs Swimming Class” at the local pool. The benefits of this process were twofold; firstly, attending these classes assisted our the mother to reclaim her parental role both from her and her son’s perspective by being together with him within her community and partaking in a mutually enjoyable activity. Secondly, the activity of swimming classes was chosen specifically to assist in the building of trust, bond and attachment between Mother and child. It was observed that in a short period of time this little boy was preferentially approaching his Mother to have his needs met and for comfort if he was sad or hurt.

46. Case Study • Program Intervention One Mother during assessment had identified that routine had historically been very stressful for her, in particular the period in the morning when she had to get her 3 young children to school. She identified that this was a time she would frequently become overwhelmed and break down. This became an agreed program intervention goal. In order to support her during the initial stages of transition, the restoration caseworker would attend the family’s home at 7 a.m. on weekday mornings in order to support and assist her to implement the routine they had worked on during the restoration assessment phase. This level of intensive assistance supported this mother who became competent in enacting a viable routine and within a few weeks she was able to enact it on her own.