Findings: Service integration and coordination

To what extent are mechanisms in place to ensure information is shared and used?

PwC interpretation of the Statewide Concept indicates that information sharing procedures between The Orange Door and referring bodies are intended to address the following issues:

1. Clients and their needs aren’t missed.
2. Duplication of effort is minimised.
3. Comprehensive risk assessment and management is based on the best information available across the system.
4. Information is shared, used for service delivery and for referral to keep perpetrators in view. (Section 5.3 includes further detail on how The Orange Door is working to keep perpetrators in view).
5. The Orange Door workers, professionals and community organisations can easily access information about where to connect clients to.
6. Sensitive information that practitioners have access to is managed carefully.
7. A feedback loop about people’s engagement with services in and beyond The Orange Door can be established.

Some information sharing procedures between The Orange Door and referring bodies have been established and these appear to be driven by FSV and the partnerships in each area. Based on evidence from fieldwork, there remains significant work to realise the intended extent of information sharing between The Orange Door and referring bodies. This is to be expected so early in implementation. This evaluation focused primarily on information sharing within The Orange Door at this early stage of implementation.

Table 8: PwC analysis of the extent of information sharing and information management within The Orange Door

The evaluation examined information sharing within The Orange Door, and identified enablers of information sharing and use within The Orange Door including:

• Commitment by FSV and The Orange Door staff to sharing information. Evidence from fieldwork indicates that all practitioners believe information should be shared where practicable and safe and where allowed under the information sharing legislation. Furthermore, information sharing is a key concept in the service model and specifications developed by FSV, highlighting its importance to the reforms.
• Recently enacted legislation enables greater information sharing (see Section 5.3).
• The introduction of the CIP, which not only provides far greater information than previously (through a consolidated report of key public sector agencies information), but also has the potential to make it easier to obtain information and improve information sharing (see Section 5.3).
• The varied backgrounds of The Orange Door practitioners. The Orange Door brings together decades of experience across the family violence, perpetrator and child wellbeing sectors into one place. Colocation and multidisciplinary practice have enabled The Orange Door practitioners to learn from their colleagues and share information about services in the sector.
• The partnership model. The Orange Door partnerships have the potential to provide the foundations for the structure of information sharing within the partnership, which can be leveraged to provide a model for the broader sector. Currently, the way information is shared within the partnerships is through their practitioners collocated in The Orange Door and their connection with their employing agencies, and through HLG and OLG meetings.

The barriers to information sharing and use include:

• Accountability for enabling information sharing. At this early stage in the establishment of The Orange Door, at an operational level, it is not clear which role or group is accountable for developing the protocols and systems required to effectively share and use information within The Orange Door. All practitioners should be undertaking information sharing and using policies and procedures to facilitate this. Organisations also need to be providing leadership, and in time, this ultimately needs to be maintained as a shared responsibility. Although information sharing requires extensive collaboration across organisations, one individual or group ultimately requires the authority to progress this work, make difficult decisions and report on developments during this early stage of implementation of The Orange Door.
• Siloed information collection databases. One of the primary rationales for CIP’s existence is that information about people is held on individual services’ databases. The CRM is a further addition to the number of databases recording data about people, but has replaced the Integrated Reports and Information System (IRIS), HDC, SHIP and other case management databases in The Orange Door areas. Information will not be effectively shared until individual databases are able to ‘speak to each other’. The siloed nature of the databases mean that practitioners and case managers often need to duplicate recording work undertaken by other agencies on their own database.
• The model is not designed as a closed loop system. The Orange Door is intended to primarily undertake an ‘intake and assessment’ function, with the primary goal being to connect clients with services as quickly and effectively as possible, rather than guiding clients through every stage of support. As discussed in Section 4.1.1, formal feedback mechanisms have not yet been established and it is not clear to The Orange Door practitioners how these mechanisms would operate in practice.

Key finding 53:

Information sharing within The Orange Door would be strengthened and duplication of effort reduced if practitioners were easily able to access information about the range of services that clients can connect with, and a feedback loop (review and monitoring system) with the sector was established.

Key finding 54:

At this early stage of implementation of The Orange Door, at an operational level, the responsibility for operationally supporting information sharing appears to be pooled between the Service System Navigator, the HLG, the Hub Manager and FSV, meaning no one person or group has overall accountability at this point in time. This may be appropriate in the longer term, but in initial implementation stages, it would benefit from one role taking initial leadership.

To what extent is information sharing contributing to effective assessment and coordinated response to family violence risk?

The evaluation was only able to examine this issue from one side (The Orange Door sharing of information, and coordination of responses within The Orange Door) through practitioner interviews, data analysis and peak stakeholder interviews. To fully understand the extent to which information sharing is contributing to assessment and coordinated response, further investigation is needed to understand the experience of the service system with which The Orange Door interacts, shares information and refers. Please note Sections 4.3 and 5.3 discuss similar evaluation findings (with a focus on risk assessment). Key mechanisms for sharing of information into The Orange Door are discussed in Section 5.3 and relate to the CIP, CRM, use of partner agencies’ client databases and multidisciplinary practice.

At this early stage of The Orange Door service delivery, the evaluation is unable to determine with certainty the extent to which information sharing within The Orange Door is contributing to a coordinated response to family violence. To do this, investigation is needed into the impact of information sharing from the non-The Orange Door service system. The evaluation is however able to provide evidence of the ‘direction of travel’ towards this goal[1].

The CRM is a database that practitioners in The Orange Door from multiple employing home agencies are able to use (providing they are practitioners of The Orange Door) and has the potential to be a key source of information sharing. Initial functional problems are being addressed through iterative upgrades to the system, and as data recording accuracy and comprehensiveness is improved, this should provide a key mechanism for information sharing via practitioners in The Orange Door.

Utilising the client data bases of employing home agencies is a key way in which The Orange Door is currently sharing information for the purposes of coordinating responses to family violence. When a referral to The Orange Door is made, practitioners check their home agencies databases to determine if previous services have been provided to the client, or if there is pre-existing information that can be shared. Practitioners indicated that where there was a pre-existing relationship, this assisted in making a timely referral to that agency to reinstate supports or to have the agency share information with The Orange Door to inform the risk and needs assessment.

The evaluation found that CIP is a key mechanism for sharing information, and there is good evidence that CIP reports are used to coordinate responses to family violence. There was evidence from practitioners that CIP reports were used to share information within The Orange Door to improve immediate risk assessment but also as a means to facilitate access to family violence services in a timely manner. For example, there is evidence that the information in the CIP reports is used to justify and expedite access to family violence case management in the context of waiting lists for this service. It is unknown from this evaluation if information from CIP reports is shared with clients, or if (and in what ways) this information is shared with agencies the client is referred to.

Case example

In response to a CIP request, a member of the CIP team called The Orange Door practitioner ahead of the provision of the written CIP report to advise that the CIP process had identified that the perpetrator was to be released from prison within the next 24 hours. This information was not known to the client or The Orange Door. In response, the practitioner contacted the client, and mobilised the partner agency and referring agencies to immediately put in place strategies to help keep the woman safe.[2]

Key finding 55: The information sharing that is occurring within The Orange Door is contributing to coordinating responses to family violence at The Orange Door through key mechanisms including the CRM, use of partner agencies client databases and CIP.

To what extent have The Orange Door systems and processes supported system integration and resulted in better collaboration between services

Facilitation of system integration and service access

The Orange Door is formed between government and service providers who have undertaken a formal Partnership Agreement within each area. Partnership Agreements commit the partner agencies to provide staffing to The Orange Door, as well as establishing a formal mechanism for collective leadership, shared vision, goals and actions, support integration of services, formalise governance mechanisms and create a process for dispute resolution.

In addition to the Partnership Agreements, The Orange Door concept envisaged that The Orange Door – specifically the Hub establishment groups, distinct from the HLGs – develop timely and effective referral pathways and protocols for information sharing, as well as agreements with private providers where necessary. These pathways would connect The Orange Door with statewide and local services including housing, mental health, alcohol and drugs and maternal and child health services. The purpose of these pathways and agreements is to:

• ensure information gathered about a person or family (including information about assessment of risk) can be transferred to a service directly, accurately and in a timely fashion to avoid a person having to ‘re-tell their story’ or practitioners having to complete multiple risk or needs assessments
• confirm that the service is available and suitable before the referral is made, that the referral is recorded and take up is checked following referral
• support the person to undertake any eligibility assessment process required[3]

Based on evidence from fieldwork and client interviews, we found that pathways and agreements are not yet matured enough to facilitate system integration and service access. The service model does pose some challenges to integration:

• Practitioners’ knowledge about services available in the broader sector: During fieldwork, practitioners stated that they mainly relied upon their prior experience to inform services available outside the partnership rather than any consolidated source of information about services.
• The access and referral mechanisms are not designed to deeply explore a client’s needs: Practitioners do not feel clear about how deeply they are able to explore their clients’ circumstances and attempt to address their deeper needs. If they attempt to investigate a client’s concerns around her situation and address them (for example, by referring to counselling), they are concerned that they are beginning to provide case management. If they simply refer the client/s to the family violence or child wellbeing agency in the partnership, they are concerned that they have not adequately addressed their client’s needs. This has important implications for a practitioner’s ability to make comprehensive risk assessment if they are uncertain about how deep they are able to explore needs.
• Isolated data systems for transmitting data: Data recording systems used by The Orange Door and partnership agencies do not allow information gathered about a person or family to be transferred to a service securely. Some allocations or referrals are made using a phone call, email, hard copy, or in person. None of these methods provide the depth of information to the case manager so the extent that they can pick up where The Orange Door left off and progress support to the client. The adequacy of information transferred during referral from The Orange Door to referred agencies requires investigation and confirmation by FSV as The Orange Door evolves (noting the need to comply with privacy legislation).
• Partnership organisations’ commitment to the model: Evidence from fieldwork, including from HLG and OLG meetings, indicates that some partner agencies have concerns about The Orange Door model, both in relation to how to operationalises integrated practice, and in understanding the responsibility of the Hub Manager. This inhibits integration and service access as decisions can be delayed at an HLG or OLG level. It is unclear if concerns about aspects of the model expressed by some partner organisations reflect an ongoing ‘lack of commitment’, the immaturity of collective leadership by the HLG (at this point in time of the evaluation) or a response to the early challenges of implementation. This may become clearer within each HLG over time and as the operational model evolves.
• A review and monitoring function: There is no formalised feedback loop with services outside the partnership in this early stage of implementation to determine whether the client has received service and if this service has met their needs. Within the partnership, the practice of review and monitoring is somewhat more integrated as The Orange Door practitioners are able to check in with their employing agencies (or ask a colleague to). Nevertheless, there are no clear responsibilities in The Orange Door to check up on previous allocations or referrals, nor a technology enabled solution to allow someone to do so. The absence of this function was felt by clients too. One client stated:

'Maybe maintain contact for a little bit longer than maybe just one phone call so that as you go through the process there’s still I don’t know even monthly contact. And I know that’s probably a big ask because they’re inundated with people but just to make sure that processes are running smoothly with you and if you need to be referred to somewhere else. I think a lot of the time and for me too women are afraid to even ask for [help] because and when you’ve been in an abusive relationship and particularly like me when you’ve been in one for a very long time you lose so much sense of yourself that to actually ask or to say that look I’m not really happy with this worker I need you to refer me somewhere else is perhaps something that you’re not going to do because you’re you don’t even know how to stand up for yourself. You lose that sense of self … A bit for more follow up I think. If that’s at all able to be done would be good.'– Client interview

• Perceived lack of capacity of the service system: During fieldwork, some practitioners indicated that they did not refer, or delayed referring due to constraints in the service system, (for instance, case management workers reaching their maximum number of clients). According to FSV, in almost all cases, this perception was incorrect, however, it highlights the absence of the capacity for either The Orange Door practitioners or FSV to concretely gauge supply in the service system.

Timing and effectiveness of connections to services

The concept paper states that The Orange Door will connect people quickly and seamlessly to the supports and services they need. Employing agencies can allocate services to clients, or referrals can be made to a broader range of supports and agencies. Where clients are not able to be provided with a service response straight away, their risk and needs will be actively monitored.

Based on evidence from fieldwork, connections to services are not always timely at this early stage of The Orange Door implementation.

A number of FSV staff and The Orange Door workforce expressed uncertainty about whether practitioners were taking longer to connect clients to services than anticipated due to greater effort required to assess some clients and undertake a higher level of intervention:

• Many practitioners stated that their case management backgrounds meant that they were used to supporting clients through difficult periods. They also indicated that it was difficult not to become emotionally invested in certain cases, and that clients developed a personal bond with them.
• Practitioners also stated that the services appropriate for cases involving family violence are often more predictable than those involving child wellbeing. They are more likely to require brokerage and less likely to require home visits. This means that victim-survivors of family violence can be connected more rapidly to services than can families where child wellbeing is the focus.
• The extent of assessment undertaken in child wellbeing cases means that the time between assessment of these cases to being connected with services may be longer. [4]

Clients interviewed also touched on the inability of The Orange Door to monitor connections with services:

• To one client, it appeared The Orange Door workers were not always aware of the services and products available to survivors of family violence.

'And letting you know everything that actually is available out there... And just to give you a bit more especially if like you’re new to being involved with a DV service you know it’s just we’re here as an ear or we’re here to get you out temporarily or you know which is what seems to happen a bit … Because I’ve spoken like when I’ve been speaking like I deal with [worker’s name] when I’m talking to [worker’s name] and that I was talking to another girl [worker’s name] and I’ll bring things up stuff and they’ll go I didn’t even know that existed …. I think at the intake there’s probably more that they can give you more [pause] just arm you with knowledge… If they [The Orange Door] were armed with more information and in simpler terms … I really think that overall they need more training and knowledge of the services that are out there that actually do good and actually do stuff you know. ' – Client interview

Another client stated that they had concerns about the capacity of The Orange Door to ensure connections to services delivered appropriate outcomes for clients:

'The only one thing that I can say that didn’t occur was she said to me that she felt I needed to go to [name of a sexual assault service] … and that never happened. And it didn’t happen with [name of a counselling and housing service] either. That would be the only thing I’d say. She [the worker] said she was going to talk to someone about that at The Orange Door and get back to me and that never happened. Now whether that’s her [the worker’s] fault or that’s the referral agency … I don’t know. But that would be the only negative thing I would say … It’s understandable that things slip through the net and I’m not angry about it at all because I think that the service that they provided was pretty good.' – Client interview

Two factors mean that it is difficult to quantitatively analyse the timeliness and effectiveness of connection to services and critical interfaces at this point in the establishment of The Orange Door.

• While CRM does capture the time the case was opened and the time of case closure, this does not necessarily reflect the sum of time spent on the case.
• As detailed in Section 4.1.1 and 4.3.2, there is limited follow up with external services to determine the outcomes of allocation or referral. The piecemeal nature of funding and service delivery means that tracking client outcomes may be difficult.

Improved recording of allocations of core services, referrals out of The Orange Door, and The Orange Door service response on the CRM will be required in order to conduct further quantitative analysis of allocation and referrals out of The Orange Door.

Key finding 56:

The nature of assessment reported to be required in child wellbeing cases means that the time between initial intake, assessment and then referral to services may be longer than for other types of cases in The Orange Door.

Key finding 57:

Connections to services may be delayed and may not always be effective for a variety of reasons. These include difficulty in obtaining information required for assessment, lack of knowledge and clarity amongst The Orange Door practitioners about the services available and the undeveloped nature of the ‘review and monitoring’ function at this point in time.

Key finding 58:

Some clients interviewed indicated that they believe that The Orange Door does not have sufficient understanding about the service response needed or available within the broader service system. This may be a point in time finding from the evaluation and would require validation with additional clients before firm evaluation judgements could be made about if this will be an ongoing experience of clients.

[1] Please not, that there is a Monash University review of the Family Violence Information Sharing Scheme underway and due to report in 2020. The review will consider any adverse impacts or unintended consequences of the scheme – and the findings from this evaluation may inform this review.

[2] Qualitative evaluation evidence from fieldwork

[3] FSV, ‘Support and Safety Hubs: Concept paper’, July 2017.

[4] Qualitative evaluation evidence from fieldwork