Strong Start Service Model

Introduction

This document provides an overview of the Strong Start Program and the context of where it sits within the Child and Family Support System. It articulates the scope of the program, key values and principles, objectives, and outcomes. The service delivery practices, outputs and service elements are described, and the service flow is represented.

This document should be read in conjunction with Department of Human Services and Safer Family Services policy and practice guides

Child and Family Support System

During 2018–2019 the SA Government undertook an extensive process of research and co-design aimed at drawing on evidence-informed knowledge and practice. This was combined with lived and professional experience, to design the Child and Family Support System (CFSS) to ensure that South Australia delivers the best possible outcomes for children and families.  The remit of the CFSS is to work with families to support them to keep their children safe and well at home in family, community, and culture.

CFSS has a focus on the following four priority population groups:

• Young parents (where mothers are aged under 23 years and fathers aged under 25 years)
• Families of infants deemed to be at high risk in their first 1,000 days
• Aboriginal families with multiple and complex needs
• Young people experiencing vulnerability and at risk of having children who may go on to enter the child protection system

The Department of Human Services has lead responsibility for implementing the CFSS, in which Safer Family Services plays a key part.

Safer Family Services (SFS) provides help and support to children and their families at risk of harm, neglect, and/or domestic and family violence. SFS purposefully and assertively intervenes to disrupt the patterns of intergenerational trauma and increase the number of children able to be safely cared for in their homes, and to remain connected to culture and community. This is particularly relevant for children and families with multiple and complex needs.

Strong Start

Strong Start is a program within Safer Family Services (SFS) which plays a critical role in the delivery of the CFSS.  Strong Start provides direct services to first time parents (where mothers are aged 25 years and under), through the antenatal period, and their infants pre-birth to 24 months.

Strong Start works collaboratively with other SFS services, government, and non-government partners to improve the social, health, and wellbeing outcomes for infants, children, and young people in South Australia.

Vision

That children are safe and well at home, in family, community and culture. Parents/caregivers of infants and children are connected to supports within their local regions, that will enhance infants, children, and parents/caregiver’s development, and strengthen the adult-child caregiving relationship.

Guiding Values

Strong Start is underpinned by the values that are guided by the United Nations Convention on the Rights of the Child (1989) and consistent with Safer Family Services Case Management Framework (2020).

• All children have the tight to grow up in an environment free from neglect and abuse. Their best interests are paramount in all decisions affecting them.
• Improving the safety and wellbeing of the children is a national priority.
• The safety and wellbeing of children is primarily the responsibility of their families, who should be supported by their communities and governments.
• Australian society values, supports and works in partnership with parents, families, and others in fulfilling their caring responsibilities for children.
• Children and their families have the right to participate in decisions affecting them.
• Policies and interventions are evidence informed.
• Children’s rights are upheld by systems and institutions.

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Guiding Principles

Many services and programs including Strong Start are playing a critical role in supporting families to keep children safe and well at home and reduce the need for children to be removed from their families to ensure their safety.

Strong Start is guided by the principles of the Case Management Framework that works with the family, whilst keeping a Child Centred approach. This is done through:

• Proactive engagement
• Strengths based approach
• Logical processes
• Partnership with children, families and partnering agencies
• Systemic links to broaden referral pathways
• Outcomes driven to achieve family’s goals
• Culturally responsive in an inclusive approach that respect culture and see culture as a strength
• Holistic processes to encompass all factors to the child and family’s safety and wellbeing
• Dynamic to be open to change and responsive to needs as they arise

The CFSS is made up of a spectrum of services that are able to respond to different degrees of complexity and the safety concerns for children and families. These services work directly with families to ensure their safety and wellbeing. Services providers are governed by their own core principles informing service operation, which spans from community capacity building through to intensive case management.

The Roadmap for reforming the Child and Family Support System 2021–2023 outlines key steps that the Department of Human Services is taking to improve early intervention services for children and families with complex needs. These steps are in line with the whole-of-government strategy, Safe and well: Supporting families and protecting children.

Strong Start will also be guided by the Aboriginal Co-Design Principles (PDF 312.7 KB) identified throughout the CFSS Co-Design Process undertaken in 2019. These principles include:

• Aboriginal and Torres Strait Islander children are front and centre
• Services are family focused
• Cultural strengths are reflected
• Aboriginal and Torres Strait Islander’s right to self-determination is reflected
• The truth of our shared histories, the hurts, the strengths, and the healing are acknowledged and reflected.

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Aboriginal Cultural Practice

The over representation of Aboriginal children and families in contact with the statutory child protection system is well documented. We see and acknowledge that Aboriginal people experience disproportionate levels of disadvantage and hardship, along with continued negative impacts from historical events and policies. Strong Start recognises the ongoing impact that colonisation, dispossession of land, and loss of culture has had on community. Strong Start is committed to developing an appropriate service response for Aboriginal children and families and sees culture as a protective factor.

Strong Start is committed to working restoratively, building on the resilience and strengths of Aboriginal people, working with, listening to, hearing, and acknowledging cultural identity, and translating this into practice.

Engaging with families with multiple and complex needs, in the best interest of the children and young people, often means working within an environment that is dominated by fear and anxiety due to the power imbalances. Assertive engagement and relationship-based case management are the approaches used to deliver support. For Aboriginal children and families, support and engagement to keep children safe and well is done in culturally responsive ways.

In addition, by keeping children at the centre of our involvement, we will work collaboratively with adult focused services that values Aboriginal family-led decision-making and self determination to ensure that, when they are supporting adults in families, they are mindful of children’s needs (as a priority) to be safely cared for within that family. This ensures that, when we are supporting adults in families, we are contributing to building a trauma responsive and healing system for everyone.

Service Description

Strong Start works with first time parents (where mothers are aged 25 years and under), through the antenatal period, and their infants pre-birth to 24 months, who are experiencing complex issues, to promote the optimal development of infants and children up to two years of age who may otherwise be at risk of adverse events.

Strong Start commences during the antenatal period and provides direct case management, in conjunction with CaFHS nursing, to support the family, with the aim of making a successful transition to parenting, and ensuring children have the best possible start to life.

Strong Start operates in two geographical locations: Northern Metropolitan Adelaide, and Southern Metropolitan Adelaide.

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Service Objectives

• Assertively engaging with children and families to provide high quality and appropriately tailored services, that attend to their safety and wellbeing, and improve health and developmental outcomes.
• Children and families are connected to responsive services to meet their needs in a timely manner.
• Cultural responsiveness reflected in partnership approaches in all engagement with Aboriginal and Torres Strait Islander infants and families, which includes the principle of family-led decision making, and the right to self-determination.
• Cultural and Linguistically Diverse (CALD) families will be supported in ways that acknowledges and recognises cultural diversity and practices.
• Deliver services with openness, honesty, and transparency with families, and have difficult and challenging conversations about child protection risks.
• Information Sharing Guidelines will ensure information sharing practices are followed where there is a threat to the safety and wellbeing of children and families.
• The Children and Young Person’s Safety Act (2017) and other relevant legislation will be complied with and utilised where appropriate.

Service Outcomes

The below outcomes should be read in conjunction with the CFSS Outcomes Hierarchy that provides a shared view of outcomes for all services in their efforts to ensure children are safe and well at home in family, community and culture.

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Child and Family Outcomes

• Family Safety. Children and families:
  • obtain appropriate nutrition, housing, accommodation, and financial stability to support children and families to stay safe and well at home
  • are free from family violence, abuse and neglect, drug, and alcohol abuse, physical, sexual, or emotional abuse, and harsh parental discipline
  • are supported to address their disability and mental health needs.
• Wellbeing. Children and families:
  • are supported to address their emotional well-being and reduce parenting stress
  • are supported to increase school attendance to create appropriate learning environments and connect to educational supports
  • are supported to enhance child development, child behaviours, child health and mental health.
• Family functioning. Children and families:
  • improve their relationships and parenting capacity, and learn different ways of problem solving, communication patterns, behaviour management and parenting styles, to support family relationships.
• Capability to influence decisions. Children and families:
  • are empowered to achieve personal capacity to affect change
  • develop self-efficacy, self-advocacy, and capacity to make decisions
  • achieve self-determination.
• Capability to achieve potential. Children and families:
  • develop insight into their strengths and resilience, to empower and encourage engagement with training, education, and employment, and develop personal skills.
• Access to community supports. Children and families:
  • seek help and support when needed
  • engage with support services, and extended family supports.
• Connection to culture. Children and families:
  • see strength in their cultural, linguistic diversity, and spiritual well-being
  • participate in cultural activities
  • take time to connect and spend time on country
  • seek support from cultural groups.

Program Outcomes

• Staff become stronger allies to Aboriginal people, ensuring self-reflection, practicing cultural humility and respect, and building their cultural fitness and responsiveness.
• Partnership is developed and maintained with services that support the needs of the client group.

System Outcomes

• Children, young people, and their families are diverted from the Department for Child Protection system for intervention under the Child and Young Person (Safety) Act 2017, and in turn minimising the trajectory of entering other statutory systems.
• Focus on improving safety and family functioning.
• Align outcome-focused efforts across the system, working for children, young people, and parents/caregivers to be safe and well in families.
• Influencing decisions and reaching potential through self-determination.
• Connect and support in communities and through culture.

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Service Scope

Strong Start works with first time parents (where mothers are aged 25 years and under), through the antenatal period, and their infants pre-birth to 24 months, presenting with a high level of complexity, maintaining a focus on the reduction and elimination of children protection risk and vulnerability.

Strong Start will undertake comprehensive assessments and case management for families, and seek to connect families to appropriate services in their community to address the child protection risks and support infants to thrive within their families, connected to culture and community.

In scope

• First time parents (where mothers are aged 25 years and under), through the antenatal period, and their infants pre-birth to 24 months.
• Unborn child concerns.
• Infants (pre-birth to 24 months) and their families where there are child protection risks.
• Pregnant first-time mothers aged 25 years and under who are identified as part of the major birthing hospital High Risk Infant case review meetings.
• Interagency investigations and responses, whether as lead agency (as nominated by DCP) or party to strategic discussions and assessment, as outlined in the Interagency Code of Practice.

Out of scope

• Children 25 months and over unless a sibling to a primary client.
• The direct investigative process of child protection matters that require DCP, CPS and SAPOL criminal and forensic assessments.
• Infants and families whereby complexity and vulnerability exist in absence of child protection risks.

Regions

Strong Start operates in 2 metropolitan regions of Adelaide:

Northern: Eligible referrals for families living in the Northern metropolitan regions - prioritising families living in the City of Playford and City of Salisbury.

Southern: Eligible referrals for families living in the Southern metropolitan regions – prioritising families living in the City of Onkaparinga and City of Marion.

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Service Outputs

Service Domains

Strong Start will deliver across the following service domains:

1. Working directly with infants and their families.
2. Consultation, assessment, and case management.
3. Developing and supporting community connections and service accessibility to support vulnerable children and families.

Service Elements

Strong Start offers the following service elements that incorporate Assertive Engagement and Case Management, providing:

Direct Case Work

Direct case work includes, but is not limited to, the following elements:

• Engage in and develop professional helping relationships with infants, siblings, their families, and communities.
• Home visiting to engage and support infants and their families.
• Ensure practice is informed by cultural consultation, and interpreters are used as required when working with culturally and linguistically diverse families.
• Support to engage with internal and external services.
• Delivery of agreed case planning that involves the family-led decision making.
• Co-working with other service providers including case conferencing, joint meetings, and home visiting.

Indirect Case Work

Indirect case work includes, but is not limited to, the following elements:

• Consultations with service providers regarding infants, children, young people, and their families.
• Sharing information of at-risk situations to keep infants, children, and young people safe.
• Cultural consultations to ensure cultural safety in families and communities.
• Providing support, information, and resources, in response to the needs of families.
• Attending meetings directly related to the needs of families.

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Partnership

SFS recognises that the skills, resources, and knowledge required to respond appropriately to the complex issues related to the care and protection of infants, children, and young people are beyond the capacity of a single agency.  Strong Start works in partnership and engages proactively with first time parents (where mothers are aged 25 years and under), through the antenatal period, and their infants pre-birth to 24 months, across the CFSS and with other relevant key stakeholders to support integrated responses to address the needs of children and their families. These partnerships form the basis for the successful operations of the program.

Strong Start / CaFHS Partnership

An integral partnership involves the Child and Family Health Service (CaFHS) Clinical Registered Nurse, who provides clinical nursing expertise and skills to improve client/service outcomes. CaFHS Clinical Registered Nurse are co-located with Strong Start Social Workers, providing a multi-agency, multi-disciplinary framework.

Primary partners in this work include:

Internal to SFS:

• Aboriginal Practice Team
• Safe Start (formerly CFARN)
• Child and Family Safety Network (CFSN), including external network partners
• Child Wellbeing Program
• Clinical Practice Team
• Community Development Coordinator Program
• Family Practitioner Program
• Metropolitan Aboriginal Youth and Family Services (MAYFS)
• Multi Agency Protection Service (MAPS)
• Pathways Service

External to SFS:

• Aboriginal Community Controlled Organisations (ACCOs)
• Aboriginal Community Controlled Health Organisations (ACCHOs)
• Department for Child Protection (DCP)
• Department for Education
• SA Health
• Child and Family Health Service (CaFHS)
• South Australian Housing Authority
• Non-government organisations
• SA Police.

Partnership Principles

• Communication that is clear, regular, timely, and relevant, underpins quality partnership
• Appropriate information sharing can contribute to keeping children safe
• Respect for each other and the strengths and contributions that all parties bring to the work
• Clarity around the roles and responsibilities supports improved outcomes
• Shared commitment to the best interests of the child
• Valuing the voices of Aboriginal and Torres Strait Islander peoples
• Self-determination and the values that underpin the right to one’s own economic, social, and cultural developments
• Valuing diversity and celebrating difference
• Perseverance in finding solutions to issues as they arise
• Transparency about organisational agendas and future intentions
• Equality between agencies delivering services.

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Practice Approaches

Outcomes - Short (0–3 months)

Mother

• Rapport established between mother and worker.
• Mother/family engage with worker/service
• Increased trust (mother - worker)
• Ante-natal needs met
• Increased housing stability
• Increased financial stability
• Increased parenting/child safety knowledge
• Acquire safe baby gear
• Drug and Alcohol harm minimization
• Link in with other support services (e.g domestic violence)

System

• Child protection concerns assessed
• Responses delivered within a holistic case plan approach.
• Appropriate referrals made to other service providers
• Increased family stability
• Work collaboratively with CFSN partners and handover cases where needed
• Increased stakeholder collaboration regarding decision making and sharing of risk
• Earlier engagement of families into services who may not have been otherwise engaged.

Outcomes - Medium (3–6 months)

Mother/baby

• Greater stability (in some cases)
• Better able to navigate difficulties
• Increased trust
• Increased understanding of the system
• Increased understanding of own agency
• Decreased fear of removal
• Increased understanding of ramifications of actions, leading to
• Increased engagement with support services
• Increased understanding of importance of contraception.

System

• Maintain good relationships with mother/family
• Able to have difficult conversations
• Improved communication channels
• Able to receive information regarding concerns
• Earlier notification re concerns
• Increased capacity of the stakeholder network to identity and respond to child protection concerns within their client base
• Increased skills and capacity of stakeholder network
• Stakeholder workforce have increased skill level to support effective responses in pre-statutory child protection work.
• Reduced duplication of services.

Outcomes - Long (6–12 months)

Child

• Receiving CaFHS checks every 3 months
• meeting developmental milestones
• Increased protective factors
• Receiving relevant allied health supports (physio/speech pathology)
• Safe at home
• Mother/family
• Greater stability
• Improved support networks
• Receiving ongoing support relevant to need
• Safety needs met
• Increased confidence to seek/access support
• Managing contraception
• Reduced risk of second pregnancy.

System

• Stakeholder network responds to child safety and protection concerns
• Agencies have up to date information.
• Agencies have access to consultation
• Earlier identification of infant’s needs and family strengths
• Coordinated service response
• Under ISG understand the need for strategic planning re child protection concerns.

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Appendix B: Acronyms

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Appendix C: Glossary