Industry discussion: Changing human services to improve client outcomes

1. Industry discussion: Changing human services to improve client outcomes Table topics – summary of key points from 18 August 2010

2. Common themes across the six topics A client-centric model • Develop a client–centric framework • More flexible funding models are required. • Develop flexible and diverse services to support a client-centric system • A ‘no wrong door’ model for client entry • Bushfire case management role provides a model for working across service types • Greater investment in early intervention services is required Improved performance and measurement • Develop an improved outcomes and measurement framework Human services as an industry • Collaboration is needed in the very early stages of service planning • A whole of Victorian Government approach is required to support the partnership • Enable better sharing of data and reporting systems across sectors • Develop an industry-wide approach to media management that promotes a positive image of human services • Reorganise the service system • Focus on whole-of-community responses as well as individual client approaches A human services work force • Develop the career potential of the human services industry • Aim for a sustainable, portable, capable and responsive work force • Re-organise work to be less structured around program / service silos • The concept of multi-purpose workers and teams

3. Topic 1: Building client and public confidence in human services Building public confidence – Comments • Confidence is undermined by negative media which often lacks the context. • Perceptions of deserving and undeserving people are reinforced. • Media focuses on the shortcomings of published reports on human services (e.g. VAGO, Ombudsman). • Roles within the human services industry at times are unclear (e.g. DHS as policy setter, funder, regulator and service provider). • Is DHS the best option for some service provision? Building public confidence – Possible actions • Collaborative service planning - develop a collaborative industry strategy that clarifies roles and reflects the shared commitment to improving lives and reducing disadvantage (clarifying roles within the competitive environment for both funding and workforce). • An outcomes framework should be implemented across the industry. • Develop a collaborative industry media strategy and proactive media responses (e.g. Publish collaborative response to VAGO recommendations, report achievements). Highlight the shared commitment to client outcomes. • Ensure clear messages and consistent language is used with measurements of what we do and the costs attached. • The principles and initiatives of a Fairer Victoria has wide public support. Reporting the achievements and impacts from this could assist confidence in the industry. • Develop proactive media campaigns that inform and educate the general public about the shape and size of the sector. • Implement routine strategic audits of the human services industry by external bodies. Building client confidence– Comments • There should be ‘no wrong door’ for clients through which to access services. • VCOSS research indicates that clients have confidence in the combination of the non-government sector and the government delivering human services. • Cultural differences across community service organisations, the Commonwealth and State governments creates an inconsistent service delivery experience for clients. • Some clients have difficulty in navigating the system. The system is large and diverse. • Service provision, configuration and funding should reflect cultural and historical experiences. Building client confidence– Possible actions • More feedback opportunities for clients need to be provided. • Share learnings across the program and service types and across geographic areas. • Funding needs to be structured to reflect a client focus, ie flexible funding models.

4. Comments The importance of flexible services and funding models to support changing demand is fundamental. Operationalising change will be difficult– we need to bring in a culture of change, supported by flexible funding Balancing personal responsibility vs State responsibility vs community expectations is a challenge in growth areas. Service delivery with the client at the centre and the client as customer can still be improved – corporate and business sector cooperation and involvement could assist. Traditional workforce models and demographics are no longer appropriate for the new more complex needs of clients. There is a workforce alignment issue. Currently workforce model are trapped in silos. Current capacity building initiatives for organisations may not be flexible enough to meet the changes. The need is to build sustainability, portability and progression at all points in human services. The risk averse nature of government does not support responsiveness to change. Possible actions Learn from relevant examples of best practice in relation to flexible, client focussed services (e.g. Bushfire response flexibility = best practice). Youth services sector also provides examples of good practice in flexible responses and funding models with the young person at the centre. Build stronger relationships between data, analysis and forward planning. Communicate the need for stronger links between data and responses. Topic 2: Aligning services to changing demographic demand

5. Comments Reform is difficult. It is limited by current funding arrangements, inadequate resources, lack of capacity and staff turnover. How do we measure client satisfaction and outcomes? How do we measure improvement? Client choice is lacking. How do we generalise the concept of individual support packages? Cultural change required so that clients don’t have to fit or understand the bureaucracy or organisations, rather we fit around them. Workforce capacity needs to be expanded regarding the skills base but the lack of resources needs to be addressed. The State government doesn’t hold all the levers eg. There are multiple funding streams to community sector organisations and the Commonwealth government is also active in many areas, ie. The system is very large and difficult to change. The capacity to change varies across the sector and there are limited resources to effect change. Stakeholders (clients, advocates and families) need to know how and where they fit. We need to be positive with the media and the government needs to be more brave. Cooperation vs. Competition within the industry. Its not just about more services but about more diverse services. Possible actions Connect client feedback and think as an industry. Reform funding and governance to support a client-centric model. Develop client–centric key performance indicators and measures. Overall coordination is required to ensure the client is getting what they need. Identify what works / best practice in the current system for clients and build on that. Changes or reforms need to be informed by input from clients, ie client involvement in program / service design Work with clients to determine the service and the service outcomes they require. Develop a responsive workforce. Develop multi-disciplinary and streamlined services with links between DHS and other Government agencies. Topic 3: Designing a more client-centric industry

6. Comments Community services employers need to become ‘employers of choice’. Barriers include: low rates of pay, poor conditions, lack of career progression (except into management roles that distance workers from clients). It’s very challenging work, complex, relentless - difficult roles in an environment that appears to ration services. Disparity between sector and the department, ie a sense that the sector ‘trains’ and the Department ‘steals’ Ageing workforce. We need to build a diverse demographic profile amongst workers that reflects the profile of the general population. There are difficulties for people wanting to move across workplaces and service types – it’s too siloed. Possible actions Promote human services work as a career. Develop career paths. Provide general support for greater professionalism and career structure. Provide the right level of supervision, support and training to support quality. Examine the place of and approach to training, including the role of universities & identification of generic competencies. Develop workforce models that transcend sectors. (Multi-disciplinary teams might be one good model, however we need to be respectful of the differences in the sector and the different organisational cultures). Change the view of the community (potential recruitment pool) regarding the human services industry (e.g. NSW made a significant investment (apparently $4M?) to promote the industry). Develop program structures and funding that supports a client-centric approach. Focus on outcomes rather than system entry. Develop a multi-skilled workforce with improved capabilities. Funded body in DHS and same in sector – working together Explore a case management approach where the generic skill is relationship building and problem solving & then seek the specialist services needed. At an organisation level develop the capacity to share investment in training with a number of organisations Exchange workers across the industry to expand experience and capacity – develop permeable workforce strategies. Topic 4: Developing a sustainable and responsive workforce

7. Comments Investment in early intervention competes with resources invested with the client. Early intervention requires a strong universal / primary support system Existing structures (bureaucratic and organisational) are a barrier. Approaches to capacity building need to be both broad and specific – community wide and individually based. Building a stronger evidence base is paramount (particularly around early intervention and knowing what works). The current way of working is more about crisis management (ie responding to individual crises), than it is about early intervention (i.e. be cognisant of the broader context in changing how we work and informing a focus on early intervention). Building more constructive and strategic relationships with government (specifically, central agencies such as Department of Treasury & Finance) is really important particularly in promoting the work we do and being able to influence funding decisions to support this work. We need a clear vision of how to transform the system. Clarity is required about what outcomes are required with effective measurement methods in place that produce a longitudinal focus. Possible actions Operate a dual system while transition to a new system occurs. Scope cost of doing nothing (now) against costs (savings) for acting early – demonstrate the links between investment early and better outcomes. Provide cohesive / joined up reporting systems across sectors. Develop a predictive – risk model (early identification of risk factors to increase range of viable response options). Develop links with non-crisis services. Increase education and knowledge of existing services that are available to families. Explore intervention science. Focus on area/place based interventions as distinct from a focus upon ‘at risk’ populations (consider the broader community context) across primary, secondary and tertiary services. Topic 5: Building capacity to intervene early to reduce disadvantage

8. Comments ONE DHS is not enough and must include other funding bodies – i.e. ONE Vic Gov. Introduce demand management when demand growth exceeds funding growth. There is difficulty in aligning required outcomes when the activity is client focused and greater flexibility is required, i.e. some solutions are not individual but group, but funding remains targeted to the individual. Information privacy issues present difficulties for one DHS. Partnership development - workforce issues present a challenge (i.e. DHS compared with sector) How to turn measures and outcomes into industry performance? Individual vs. systems level? Outcomes at individual level vs. industry based performance? Housing workforce – can it be used as a triage function? Potential improvement barriers include: area-based planning; investment choice; agreed area priorities; bringing partners together; need is out of city (growth areas); how to service? Is major industry reform needed? Focus on support, performance and funding. Possible Actions Partnership development – the community sector needs to be at the table. Must determine the existing strengths and weaknesses and share learning. Develop a client-centric framework. Develop a measurement framework and bench marks (e.g. tertiary participation measure, income, rewarding careers, variety). Move to a genuine outcomes focus rather than outputs (e.g. Measures around outcomes for people, outcomes for minimising gap). Make incentives more efficient and constructive. Establish clarity in relation to the respective roles and define what the industry is. Reduce duplication in engagement and monitoring – i.e. multiple “partnership agreements” across Govt for agencies. Establish a greater focus on early intervention / prevention for future sustainability. Cut through the disadvantage cycle / measure trans-generation improvement. Reduce DHS involvement in direct service delivery, except for statutory areas. Establish the ‘Bushfire model’ systems navigator for disadvantaged sites? Topic 6: Improving industry performance and outcomes