PRACTICE FRAMEWORK FOR

OUT OF HOME CARE

Empowering people with additional needs to achieve their vision of a good life by delivering excellence in support.

01 > FROM THE CEO

02 > BACKGROUND

03 > PRACTICE DEVELOPMENT

FRAMEWORK

04 > OPTIA’S VISION, MISSION & VALUES

05 > PRACTICE: APPROACHES

& ACTIONS

09 > CASE STUDY: HOW DOES THIS

FRAMEWORK WORK FOR TOBY?

CONTENTS

FROM THE CEOAt Optia we have a very clear mission of providing service excellence, to ensure that everyone we support has the maximum potential to lead their vision of a good life.We are conscious that we exist in an environment that is changing rapidly and it is essential that we have the capability to evolve and innovate. We need to ensure that our practices are world class, are demonstrably based on sound evidence and are embedded in a clear set of strongly held underpinning values.

We have been meticulous in crafting a robust and well informed strategic direction for the organisation based on best practice, quality assured service delivery; first choice client facilities; sector-leading innovation; trusted partnerships and the most capable staff with aligned values.

Together, we have developed an aspirational set of values, building on a long history of providing client-focused services. Our values respect and honour our past, but also look strongly to a future full of promise and challenges. As an organisation we need to be robust, flexible and innovative. We need to maintain a laser-like focus on our clients and their growth, aspirations and human potential.

Our values form the bedrock on which our practice is based. But our practice also needs to evolve and to always reflect the best practices and contemporary research and evidence. Our Practice Framework provides the capability to continually identify and assess emerging and leading practices; to identify and evaluate the best evidence available and to continuously test our practice against the highest possible standards. It is only this way that we are able to deliver our promise of ensuring all of our clients have the maximum opportunity to achieve their own potential.

GLENN CAMPBELL Chief Executive Officer

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Optia is a Tasmanian not-for-profit organisation that provides state-wide support services to people with disability, additional needs and children in Out-of-Home Care.

OUR SERVICES INCLUDE:

Supported Accommodation

Respite Accommodation

Community Support and Access

Semi-Independent Living

Leisure and Recreation

Specialist Support Services

Out-of-Home Care

A Practice Framework for Out-of-Home Care is designed to be a best-practice guide for Optia staff, grounded in core organisational values, legislation and evidence-based research.

The Framework reflects recent disability and Out-of-Home Care reforms in Australia and focuses on high quality, person-centred service provision.

In accordance with the National Framework for Protecting Australia’s Children, Optia believes:

“All children have the right to be safe and to receive loving care and support. Children also have a right to receive the services they need to enable them to succeed in life.” (COA, 2009, p. 6)

Optia creates safe, secure and predictable environments for children and young people. We build trusting relationships, communicate expectations, listen and act consistently. We restore and improve the health and wellbeing of the children and young people in our Out-of-Home Care environments.

Optia provides individualised support planning and includes children and young people in decision-making. Increasing placement stability is a priority, and we create opportunities for self-discovery and personal growth. Optia works to ensure children and young people have access to education, and encourages engagement in learning and skill development. Our approaches are positive, child-centred, inclusive, trauma-informed and evidence-based.

A Practice Framework for Out-of-Home Care allows us to better meet the needs of the children and young people we support. It centres on the individual and realises the importance of creating positive, nurturing environments.

ABOUT US

BACKGROUND

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Out-of-Home Care service models and practice frameworks are grounded in key principles and legislation (e.g. COA, 2011; COA 2009; DHHS, 2008; United Nations Convention of the Rights of the Child, 1989). Standards such as quality, safety and protection are related to upholding personal rights and justice. Optia’s Practice Framework is informed by these same standards, and also by our own core organisational values.

LEGISLATION, STANDARDS

& PRINCIPLES

AGoodLife

ClientOutcomes

Research

Evidence

Practice(Approaches & Actions)

Organisational Strategy

Legislation, Standards, Human Rights & Governance.

OrganisationalValues

Purpose(Mission & Vision)

leads to

ensures

drives

underpins

assures

produces

informs& guides

PRACTICE FRAMEWORK

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VALUESHUMANITY

Human rights and dignity underpin all our decisions and actions. We believe that every individual has the potential to grow and the right

to determine how their life will be lived.

HONOURWe take pride in our work, are true to our word, honour our

commitments and treat our colleagues and clients with integrity and respect.

INNOVATIONDriven by our commitment to excellence, we are continually learning, taking on new challenges, and constantly finding ways to excel in the

dynamic world we operate in.

ACCOUNTABILITY We know where we are heading and why. By being efficient, effective

and persistent we find ways to make things possible and deliver results.

OUR VISION

OUR MISSION

That all people supported by Optia

will have the maximum potential to lead a

good life.

To empower people with additional needs to achieve their vision of a good life by delivering excellence in support.

OPTIA’S VISION, MISSION & VALUES

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The key focuses of recent Out-of-Home Care reforms have been in relation to quality and safety in service provision. There is a demand for approaches that increase placement stability, are child-centred, and responsive to need. The practices we employ must also be appropriate for supporting children who have experienced trauma (see the National Framework for Protecting Australia’s Children and the Integrated Strategic Framework for New Directions for Child Protection in Tasmania).

Optia’s practices are therefore guided not only by our purpose and values, but also by the current directions in the sector and evidence-based best practice demonstrated through research.

OPTIA’S APPROACHES INCLUDE:

Child/Youth-Centred Approaches

Inclusive Practices

Trauma Informed Practices

Positive Behaviour Support Approaches

PRACTICE: APPROACHES & ACTIONS

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CHILD/YOUTH-CENTRED APPROACHESAll actions by Optia staff aim to achieve the desired outcomes for the individual child or young person, including short-term goals and life goals (see Stirk & Sanderson, 2012, p. 13). The child/young person is always included in conversations, planning and decision-making (see COA, 2011; COA, 2009; UNICEF, 1987).

SOME OF OUR ACTIONS INCLUDE:

understanding the child’s life story and planning according to expressed needs and life aspirations

planning with the child, family and other key stakeholders; with a focus on health and wellbeing, and ensuring the child is safe and secure

implementing, reviewing and adapting care plans to suit individual circumstances and need

providing opportunities to engage in various experiences that are meaningful and engaging.

INCLUSIVE PRACTICESThe National Framework clearly states the need to uphold the child’s right to participate in decisions that affect their life and to feel a sense of belonging. The literature more broadly also demonstrates a need for children to have a sense of belonging through stability and security.

OPTIA THEREFORE:

creates warm, caring, secure, and familiar environments that empower children to make choices

keeps children safe and protect them from harm

establishes routines, clearly communicate expectations and act in a consistent manner

create a sense of home, where ‘home’ is defined as: “A home is not merely a shelter. A real home has hearth; a sense of warmth and comfort. A real home has heart; it’s a place of emotional warmth and emotional connection. Home is a place of privacy where the occupant can control who comes in and who does not come in. A real home has a sense of identity. It has roots, it is where the person belongs…” (BRIAN MCCLEAN)

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POSITIVE BEHAVIOUR SUPPORT APPROACHESOptia employs positive behaviour support approaches as these are complementary to other practices including trauma-informed approaches, child-centred approaches and inclusive approaches. Further to this, the positive behaviour support model aligns with our core values and the legislation.

THE KEY ACTIONS OF OPTIA STAFF THAT ARE ASSOCIATED WITH THESE APPROACHES INCLUDE EITHER PREVENTING PROBLEM BEHAVIOUR OR REACTING TO IT BY:

creating environments designed to meet individual need, and knowing the person and their cues for communicating that they are not coping

focusing on skills development, including skills that replace problem behaviour, and coping and tolerance skills

responding to the needs that are being communicated through behaviour, and offering assistance and understanding.

(SEE LAVIGNA AND WILLIS, 2012)

TRAUMA INFORMED PRACTICESTo create a sense of home, and to abide by the principles of trauma-informed support, Optia staff start with building trust. As many children and young people in Out-of-Home Care have experienced trauma in their lives, we focus on establishing a relationship through respectful communication. We listen, ask about, and honour the opinions and choices of the children and young people we support. We recognise that people may be scared, frightened and angry, so ‘winning the argument’ is not as important as establishing trust.

Clear boundaries are communicated but staff are compassionate, and caring at all times. Promises that are made to children and young people are kept. Staff compliment and encourage the children and young people we support and find positives on which to focus. Optia is guided by the fact that children and young people who have “multiple, positive healthy

adults invested in their lives improve” (SEE PERRY, 2008). Further to this, we understand the importance of feeling connected to others:

“People who are connected to others who know and care about them lead happier and healthier lives than people without relationships.” (COUNCIL ON QUALITY AND LEADERSHIP)

Optia staff reduce arousal by creating and maintaining a consistent, safe and stable environment (see Perry, 2008). Our approach is to respond in a calm, caring manner in the face of crisis, by modelling ‘co-regulation’ (see Anglin).

WE REDUCE AROUSAL AND MODEL SELF-REGULATION BY:

providing the basic needs of shelter, food and clothing; and empowering the person to have choice, control and security of access to these

acting in a way that is consistent and predictable i.e. ‘doing what we say we will do’

teaching the person how to be self-sufficient and meet their day-to-day needs

remaining calm while connecting to the emotional tone or message the person is conveying

providing an appropriate role model to the person who is aroused

supporting the person to take cues for appropriate emotional responding

teaching the person how to regulate arousal and emotion.

PRACTICE: APPROACHES & ACTIONS

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RESEARCH & EVIDENCEThe Out-of-Home Care reform papers, strategic plans, and the National Practice Frameworks, all highlight the need for practices to be evidence-based. The practices that are currently included in Optia’s Practice Framework has been shown to be effective through published research. Further to this, these practices are consistent with Optia’s Values and the legislation and frameworks under which Optia is contracted to provide services. All of Optia’s practices are grounded in protecting the rights of the individual child or young person, and in providing high quality and effective support.

TO ENSURE THAT OPTIA CONTINUES TO DELIVER CURRENT BEST PRACTICE WE WILL:

regularly consult with and always value the input of all children and young people we support

reflect on and monitor our services by conducting research and measuring outcomes

continue to research and innovate to generate new practices and evidence

attend forums and conferences to share knowledge, learn about new directions and build collaborative partnerships with key stakeholders

monitor literature, review emerging trends, implement and evaluate new practices

regularly review the practice framework that guides our actions

promote development and provide opportunities for staff to engage with relevant education and training.

OUTCOMESOptia aspires to and achieves high standards. These standards are guided by our values, the legislation and new directions in service provision.

THE OUTCOMES WE SEEK TO ACHIEVE INCLUDE:

social and economic participation

enhancement in health and wellbeing

increased goal attainment.

The outcomes are delivered by being aware of the direction we are taking, and being committed, motivated and courageous. Achieving excellence in service provision leads to outcomes for the organisation and the individual. Social and economic participation is achieved through creating opportunities for growth, discovery and learning in secure, safe environments. This builds on skills and allows for greater engagement in the home, school and community. This leads to increased goal attainment and enhances health and wellbeing.

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Twelve-year-old Toby arrives at temporary accommodation operated by Optia on a Friday afternoon. His foster carers contacted his Case Manager that morning after an incident the night before saying his things were packed and he could not come back after school. He is transported to the house by a worker who knows nothing about his situation. The information provided is that he takes medication, that he can be aggressive, and that there is a history of physical abuse and possibly sexual abuse as well. He arrives at the door with all his possessions in two large plastic zippered bags.

The staff member recognises that Toby is likely to be frightened and anxious. First, the staff member shows Toby where he will sleep, where he can put his things, where to find the toilet and where to find food and drink. The staff member tells Toby he can help himself to anything he likes and encourages him to make a drink and a snack.

Practices:

Providing the basic needs of shelter, food and clothing; and empowering the person to have choice, control and security of access to these.

The staff member then invites Toby to play one of the DVDs he has in his bag. Over the course of the evening they assist Toby to unpack his belongings and find out what he likes to eat and favourite activities, noting this in writing. The next day a staff member talks with Toby about his food preferences, they make up a menu plan for the coming week and put it on the fridge after shopping for the groceries. All staff then follow this plan. The staff member also sets some short-term goals about things he would like to do in the coming week and checks if he has any plans for the week. Toby believes he is due to have an access visit on Thursday. The staff member emails the Team Leader to check on this.

On Monday the Team Leader contacts the Case Manager to check on this and also to ask the Case Manager to meet with Toby to give him an idea of how long he will be staying. The Team Leader visits Toby to let him know about his access visit, and organise an activity plan. Staff follow the menu and activity plan.

Practices:

Routines are established and expectations are clearly communicated.

Acting in a way that is consistent and predictable i.e. ‘Doing what we say we will do’

After Toby’s access visit he is angry and upset, yelling that no-one listens to him, that he wants to go home, throwing objects and slamming his door. Staff use active listening and offer a preferred activity of a new video game. They do not reprimand him or order him to clear up. The next day the Team Leader asks him how he would like staff to help him when he is upset. He says if he goes in his room and slams the door he wants to be left alone. The Team Leader also asks him how he is getting on with staff and Toby identifies staff he enjoys working with and others who are “boring” and “annoying.” The Team Leader adjusts the roster to phase in more shifts by preferred staff and others with similar attributes.

Practices:

Responding to the needs that are being communicated through behaviour, and offering assistance and understanding.

Remaining calm while connecting to the emotional tone or message the person is conveying

Providing an appropriate role model to the person who is aroused

Regularly consult with and always value the input of all children and young people we support.

CASE STUDY: HOW DOES THIS FRAMEWORK WORK FOR TOBY?

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“ Toby is involved in the transition, assisting to pack up his belongings, arranging furniture in the new house, and selecting a new quilt cover and posters for his room.”

After a month in this temporary arrangement Optia suggests a move to a more permanent house closer to Toby’s school. Toby is involved in the transition, assisting to pack up his belongings, arranging furniture in the new house, and selecting a new quilt cover and posters for his room. A rewards systems and daily timetables are introduced to encourage Toby to participate in household chores. The schedule is predictable. Routine is considered very important as Toby still needs to know what to expect and why, because it makes him feel safer. Staff establish trusting relationships with Toby by listening to him, reassuring him and giving him space to calm down when he needs it. It is necessary to allow Toby the space and opportunity to self-regulate his emotions.

All promises that are made, are kept. Consistent approaches and responses are employed by staff, and staff follow the same procedures around preventative and reactive strategies. Staff compliment and reward Toby when he is well presented and behaves well, and make a conscious effort to find other things to compliment him on.

Practices:

creating environments designed to meet individual need, and knowing the person and their cues for communicating that they are not coping

acting in a way that is consistent and predictable i.e. ‘doing what we say we will do’

teaching the person how to be self-sufficient and meet their day to day needs

supporting the person to take cues for appropriate emotional responding

teaching the person how to regulate arousal and emotion

Optia’s Practice Development Consultant also meets monthly with Toby so that he can raise any concerns or issues with an independent person. They also discuss the things Toby wanted in life. Some are outside Optia’s sphere of influence such as going home, however, they liaise with his Case Manager to arrange for Toby to have photos he can put up of his family. Toby talks a lot about wanting to be a “normal boy”. By this he means making friends and being able to have friends over to play or for a birthday party. Optia organises for Toby to attend Kommunity Kids, which also results in him seeing a White Lion mentor. The counselling and mentoring provides Toby with the opportunity to talk about his emotions and his life. The Kommunity Kids program allows him to socialise, engage in a range of activities, have fun in a safe and secure environment and make friendships. Some of the social skills he learnt were then transferred to the school environment. He also joined a circus program. On his birthday he had a party at McDonalds for two friends followed by a trip to the movies.

Practices:

Developing a futures plan according to their expressed needs and life aspirations

A sense of belonging through stability and security.

Creating warm, caring, secure, and familiar environments that empower children to make choices.

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USEFUL RESOURCESAustralian Government Productivity Commission (2011). Disability and Care Support. Productivity Commission Inquiry Report. Retrieved on June 26th, 2014, from: http://www.pc.gov.au/__data/assets/pdf_file/0012/111270/disability-support-volume1.pdf

Disability Services Commission (2012). Contemporary Practices in Disability Services: A Discussion Paper. Retrieved on 10th July 2014, from: http://www.disability.wa.gov.au/reform1/reform/self-direction/

Disability Services Commission (2011a). Self-directed supports and services: Conversations that matter. Retrieved on 10th July, 2014, from: http://www.disability.wa.gov.au/Global/Publications/Reform/Self%20Directed%20Supports%20and%20Services/

Self%20Directed%20Supports%20and%20Services%20%20Conversations%20that%20Matter.pdf#xml=http://www.disability.wa.gov.au/Search10/isysquery/4c6f03ff-e391-44fe-abab-a047e38c2dc6/1/hilite/

Disability Services Commission (2011b). Positive Behaviour Framework: Restrictive Practice(s) Issue Paper, Report on consultations held in Perth, Bunbury and Albany. Retrieved on 10th July, 2014, from: http://www.disability.wa.gov.au/Global/Publications/For%20disability%20service%20providers/Guidelines%20

and%20policies/Behaviour%20Support/Restrictive%20Practices%20Issues%20Paper.pdf.

Dowling, S., Manthorpe, J., & Cowley, S. (2007). Working on person-centred planning: From amber to green light? Journal of Intellectual Disabilities, 11(1), 65-82.

Lavigna, G.W., & Willis, T.J. (2012). The efficacy of positive behavioural support with the most challenging behaviour: The evidence and its implications. Journal of Intellectual and Developmental Disability, 37(3), 185-195.

Mansell, J., & Beadle-Brown, J. (2004). ‘Person-centred planning or person-centred action? Policy and practice in intellectual disability services’. Journal of Applied Research in Intellectual Disabilities, 17(1), 1-9.

Mansell, J., Elliott, T., Beadle-Brown, J., Ashman, B., & Macdonald, S. (2002). Engagement in meaningful activity and ‘active support’ of people with intellectual disabilities in residential care. Research in Developmental Disabilities, 23(5) 342-52.

McVilly, K., Gelman, S., Leighton, D., O’Nell, S. (2011). Active Support: Organisational preparation and implementation. Melbourne, Australia: Jewish Care (Victoria).

Stirk, S., & Standerson, H. (2012). Creating person-centred organisations strategies and tools for managing change in health, social care and the voluntary sector. London, UK: Jessica Kingsley Publishers.

The Council on Quality and Leadership (2010). What really matters: A guide to person centred excellence. Towson, Maryland: The Council on Quality and Leadership.

The Disability Services Commission (2013). Count Me In: A Better Future For Everyone. Retrieved on 6th October 2014 from: http://www.disability.wa.gov.au/Global/Publications/About%20us/Count%20me%20in/Count-Me-In-Disability-

Future-Directions-December-2013.pdf

The Department of Health and Human Services (2009). Operational Framework for Disability Services. Retrieved on May 15th, 2014, from: http://www.dhhs.tas.gov.au/_data/assets/pdf_file/0011/76286/FINAL_PRINTED_VERSION_IN_FC

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