Cost of Quality

1. Cost of Quality Concern about total costs of foster care programs Concern about ideal case load numbers in foster care programs Concern about permanency in placement in foster care programs Concern about resilience of children in foster care Cost of Quality

2. Find A Family • FAF of Barnardos Australia. • Intake children with parental responsibility until 18, previously state wards until 18 years of age. • Intake of children between 0 and 12 years of age. • Placement from Sydney metropolitan area, including Central Coast, Blue Mountains and Illawarra. Cost of Quality

3. Find A family • Intake slanted toward hard to place children, because of previous placement disruptions, size of family, including very young siblings or complexity of behavior . • Total number of children accepted to date 450 , currently 150 at any one time. • Assessed complexity of clients. • Barnardos ,ordinarily difficult, difficult, extraordinarily difficult. • DoCS funding, care, care plus 1, care plus 2, care plus 2+. Cost of Quality

4. Information within Barnardos • Detailed records of all placements and each move of every placement recorded. • Staff stability e.g. Senior Manager with 18 years service, plus others. • Program funding / cost centre allocations audited since inception. • Costs include corporate overheads and shared costs, and allow identification of foster carer costs, all recorded. Cost of Quality

5. FAF Practice of permanency • Children stay in current placement or if unable to do so will be placed into specialist intake foster care. • Work with children including life story book, understanding of situation and age appropriate participation in finding a permanent carer . • Planned move to permanent care with carefully matched foster carer. • Rarely placements of unrelated children in the same carer family. • Adoption is a possible case plan for all children by their current carers if appropriate. Cost of Quality

6. Record of permanency of placementStatistics • Of total of 439 as of February 2008, 74 are in intake or restored, leaving 365. • Total number of adoptions 134, (i.e. one third admitted). • Of the 365 children and young people, 288 are in the first permanent placement, 49 are in second placement, 21 children are in third and only 7 are in their forth placement. • Average age at adoption is 10 years one month. Cost of Quality

7. Longitudinal Study by Doctor Elizabeth Fernandez University of NSW • Commenced in 1997. • 59 children within the Find A Family Program. • Research involved repeated interviews at regular stages of the care process with children and young people assessing needs strengths and difficulties. • Also included interviews with case workers, care givers and educators. Cost of Quality

8. Results to date of longitudinal study • Children showed strengthening relationships with foster mothers and foster siblings. • Statistically significant changes in the positive direction in overall peer attachment. • Improved education outcomes observed with stability of placement. • Resilience improvement in relation to stability in placement. Cost of Quality

9. Expected Standards of service delivery • NSW Children's Guardian has developed minimum standards in order to accredit OOHC service providers. Audits are performed to monitor compliance. • Standards relate to care planning, oversight of placements, participation of clients, foster parents and parents, review and other critical factors, which impinge on the time needed by case workers. • FAF utilises the Looking After Children guided practice case management system, which gives time frames for visitation, care planning etc. • NSW Department of Community Services appear to indicate a preference for Results Based Accountability, rather than a process approach to funding, although measurable outcomes not yet fully identified. Cost of Quality

10. Unit costing • Many attempts world wide to clarify unit costing of Out Of Home Care. (The unit is a child or young person in Out of Home Care). • One of the best is the Cost Calculator of the Centre for Child and Family Research, United Kingdom, presented at last ACWA conference. Research included careful analysis of every cost of many different local authorities related to different children. • New South Wales endeavors to reach unit costing have experienced a number of difficulties. Cost of Quality

11. Recognised methods to reach Unit Costing • Time and motion studies of workers on the job, capturing and costing all their activities – expensive (Dianne Hudson early 1990’s points system). • Analysis of existing program costs, required known number of workers and known number of clients, (indicative program costing in current NSW costing manual helpful but uses theoretical case load number to reach unit cost). • Two critical components are the cost of a worker and the caseload of a worker. Cost of Quality

12. Cost of a case worker • Is a theoretical mix of costs included in a program divided by the number of operational case workers. • The costs should include all activities that are carried out by a foster care program, e.g. Foster care recruitment, parental contact. • Salary, supervision and support should be included and administrative and organisation costs, including travel and direct service costs. • Payment to foster carers and children not included. Cost of Quality

13. Case load • The number of active clients serviced divided by the number of operational case workers. • The definition of an active client is critical, e.g. somebody that a case worker is required to service on a regular basis. Cost of Quality

14. FAF Program Costing • Established case worker costs at $125,000 for year ending June 2006. • Adjusted total program costs for CPI to enable comparison over six year period. (the costs shown on audit were lower). • Data base maintained to inform number of children in care for each 12 month period. Cost of Quality

15. FAF Program unit cost Cost of Quality

16. Conclusion • A high level of permanency was achieved. • Resilience demonstrated by children within the program. • One third of whom were adopted. • Case load of 6.7 clients per case worker. • And further……. Cost of Quality

17. Conclusion • While the case load of 6.7 might not match a theoretical or desired case load number it is one that can be justified, in order to achieve quality. • It must be recognised that this case load is an active case load number, that is all these children were in foster placement at the time they were counted. • There is also a passive or hidden case load number of children referred, work undertaken, but not yet in placement, post adoption work, aftercare. Barnardos plans to analyse this further in the future. Cost of Quality

18. References. • Fernandez, E., (2007), Unraveling Emotional, Behavioral and Educational Outcomes in a Longitudinal Study of Children in Foster-Care, British Journal of Social Work, April 19 2007, Oxford Press. • Fernandez, E., (2006) Growing up in care: Resilience and care outcomes, in Flynn, R. J. (Ed.) Promoting resilience in child welfare (pp. 131-156). Ontario (Canada), University of Ottawa Press. • Patrick Kerlin, Senior Manager Administration, Barnardos Australia, pkerlin@barnardos.org.au • Find-a-Family presentation ‘Acknowledging the Past and Securing the Future’ 3.30pm Bayside 203. Cost of Quality