Workforce

To what extent is the integrated and multi-disciplinary approach to service provision at each The Orange Door site working to support better outcomes?

FSV developed The Support and Safety Hubs: Interim Integrated Practice Framework (‘the Interim Integrated Practice Framework’) to guide consistent practice in the first areas of The Orange Door. The framework is intended to support practitioners to deliver integrated support for clients through providing clear guidance about the requirements of their role as a practitioner in The Orange Door. Within the Interim Integrated Practice Framework, integrated practice is referred to as ‘the integration of theoretical frameworks, philosophical underpinnings and perspectives, and practice skills and approaches that guide a practitioner’s work’. Additionally, the guide notes that practitioners will be:

• required to maintain their specialisation and adopt a multi-agency approach to service delivery
• supported to develop additional skills and capability to address the safety and needs of women, children, families and men

While integrated practice underpins all work of The Orange Door, the Interim Integrated Practice Framework makes it clear that the vision for The Orange Door service delivery is that 'practitioners will be required to maintain their specialisation and to adopt a multidisciplinary approach to service delivery.'

The Interim Integrated Practice Framework refers to integrated service as 'a number of services working together, collaborating and coordinating their support, services and interventions to people seeking, or referred for, help.'[1] However, there is no sector-wide agreed understanding of what ‘integrated service delivery’ looks like at an operational level. As indicted previously, there is a lack of understanding by the workforce in how to operationalise the model in the early stages of The Orange Door.

The Interim Integrated Practice Framework has been used as the benchmark for integration, recognising that the evaluation could not assess the level of integration but could gauge the ‘direction of travel’. The Interim Integrated Practice Framework describes:

• the expected capability of the workforce at a high level – 'practitioners will be required to maintain their specialisation and adopt a multi-agency approach to service delivery'
• the expectation of practice to develop capability – 'practitioners will need to draw on the strengths and specialisation of colleagues in the Hub to gain confidence and capability to work across the range of issues experienced by people accessing the Hub'
• the expected collaboration between practitioners – 'Hub practitioners will be able to: apply their specialist knowledge and expertise into their practice with all people who access the Hub… collaborate with and draw on the strengths of their specialist colleagues as part of a multi-agency approach to practice … collaborate with their colleagues in developing integrated risk and needs assessments and planning as part of a multi-agency approach, ensuring all individual risks and needs have been analysed and considered in decision making'
• the expected integration of practice across all functions of The Orange Door
• the expected coordination of responses to 'deliver coordinated responses with their colleagues that promote meaningful engagement with services that result in sustainable outcomes.'[2]

During evaluation field work, many practitioners admitted that they had not read the guidance materials including the Interim Integrated Practice Framework. While reading core practice guidance could reasonably be expected of staff given it was identified in the orientation training, when investigated, The Orange Door staff indicated it was because of: the amount of documentation that had been produced; the length of the content;[3] and time pressures:

'No one has had the time to read [the policy documents] and embed them. So then you revert to what you know.'[4] – Practitioner interview

Those that had read the documentation did not find the content useful for preparing them to work at The Orange Door, as they expected more definitive practice based guidance including detailed examples as to how the integrated model would or could work in practice.

Generally, across all areas, there is evidence of the following aspects outlined in the Interim Integrated Practice Framework in Table 6 below.

Table 6: Interim Integrated practice framework elements evident at The Orange Door

The Interim Integrated Practice Framework has been used as a theoretical benchmark, with key elements of integrated practice in that document used to inform initial evaluative judgements on whether aspects of integrated practice (including the coordination of support) are occurring in different service delivery points within The Orange Door.

Figure 12 provides a visual overview of the point in time evidence collected for the evaluation relating to integrated practice across the functions in each Orange Door area.

Download Figure 12: Overview of integration at each function of The Orange Door (as of September 2018):

Figure 12: Overview of integration at each function of The Orange Door - as of September 2018

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As The Orange Door is in varied stages of implementing integrated practice and because we have very limited data collected directly from clients in this evaluation, the evaluation was unable to determine if multidisciplinary, collaborative or integrated practice was itself contributing to better outcomes for clients (nor does this early evaluation consider client outcomes).

A key finding of this evaluation however, is that there is a genuine commitment and enthusiasm by practitioners of The Orange Door to work in an integrated manner that builds their capabilities and confidence in working in integrated and/or multidisciplinary teams to improve outcomes for clients. This commitment is a strong foundation upon which the evolution of practice towards a more integrated vision will be achieved.

It is worth noting that the evaluation team conducted site visits and collected data from October – December 2018 and the subsequent pace of the reforms and implementation means that some of the issues raised regarding integrated practice during the evaluation have already been addressed. For example, we understand that there have been steps to introduce reflective practice across disciplines in one of The Orange Door areas since our evaluation fieldwork in order to provide formal and structural supports to encourage integrated practice. This was an opportunity identified to FSV early in the evaluation which has been subsequently actioned.

Key roles in The Orange Door that can assist in promoting integrated practice include the Advanced Family Violence Practice Lead and the Integrated Practice Lead. The formalisation of these roles is a positive foundation upon which to base evolving integrated practice in The Orange Door. Some further refinement is needed for these roles to sharpen their focus to promote integrated practice as The Orange Door model evolves (see Section 6.2).

Key finding 40:

There is a commitment from The Orange Door workforce to develop capability in other specialisations and work in an integrated manner in order to improves outcomes for clients

Key finding 41:

The length of written guidance and documents produced about The Orange Door – concepts, framework, operational guidance, etc – deters practitioners from engaging with and understanding key information to inform how they integrate services

Key finding 42:

A culture of collaboration is evolving at The Orange Door in line with the vision described in the Interim Integrated Practice Framework and tends to happen organically between individuals, and between certain disciplines

Key finding 43:

The ability of the current workforce at The Orange Door to work in an integrated manner is currently impacted by staff shortages and high demand

Key finding 44:

There are limited structural and formal opportunities for practitioners to learn about other disciplines and practice approaches. Time for reflective practice for teams would support integrated practice.

To what extent does The Orange Door workforce have the resources, capacity and specialist expertise to undertake the full range of functions articulated in the foundational offer?

The Orange Door Service Model describes a staffing model where different workforces and practices will combine to create a team and consolidated intake point for each area. This is to be achieved through a partnership of community service organisations who each contribute workers employed by their organisations to work as part of The Orange Door team. Alongside Client Support Officers (CSOs) employed staff are staff employed by FSV and DHHS (Child Protection). Each worker continues to be employed and managed by their employing ‘home’ organisation with their terms and conditions of employment being protected.

Key roles are identified in the Service Model and outlined in Table 7 which also describes evaluation findings related to each role.

Table 7: Roles within The Orange Door, allocation of roles and evaluation findings about roles

The evaluation found that the staffing for The Orange Door has been challenging in the initial set up and implementation phase for all areas including:

• Challenges in recruiting appropriately qualified and experienced staff due to a scarcity of experienced workers more broadly.
• A lack of alignment between workers expectations of their roles (and position descriptions) and the reality of their roles within the service model.
• Workload for practitioners from the combination of under-staffing, set up demands and almost immediate backlog in cases (in some cases due in part to partner organisations bringing across existing backlogs).
• A lack of ‘lead in’ time for practitioners to acclimatise to the environment, service delivery context and new systems prior to service commencement.
• Insufficient work spaces to accommodate the workforce for some areas (BPA and Barwon) during the early months of service commencement.

Despite the challenges, the evaluation found strong evidence that the workforce are committed to the concept of The Orange Door and were persisting with finding solutions to operational challenges to try to ensure services were delivered to clients.

Key finding 45:

There is a lack of operational clarity and understanding for The Orange Door workforce about the role of the Integrated Practice Lead and the Service System Navigator during the early roll out of The Orange Door

Key finding 46:

There is a perception that the Advanced Family Violence Practice Lead role pertains only to practice with victim survivors. Although the Advanced Family Violence Practitioner role was established to provide guidance to both victim survivor and perpetrator workers, workers perceive that there is a gap in leadership for perpetrator services

Key finding 47:

Additional and/or different resourcing is needed to account for establishment demands, peak demand times of the year and to accommodate staff leave arrangements during the Christmas and the New Year period

To what extent does The Orange Door workforce have the skills to recognise and manage signs of family violence, including perpetration, and child vulnerability

Capacity for recognising family violence and perpetration

The evaluation found that many practitioners entered The Orange Door with skills in recognising and responding to family violence. These skills and knowledge were reflected most strongly in practitioners who had previously worked with victim survivors and who were experienced in using risk assessment frameworks similar to those now used in The Orange Door. Similarly, those who had worked with perpetrators entered The Orange Door with a suite of practice skills and interventions aimed at recognising escalating risk with men, and the use of interventions and other resources to try to mitigate risk. For the workforce who had experience in child and family services, many had exposure to identifying and managing risk where there were concerns about family violence as a factor in child wellbeing cases (noting not all child wellbeing cases involve family violence). The inclusion of practitioners with skills in recognising and responding to family violence perpetration at the outset of The Orange Door has meant that many are able to focus on learning new systems and process of The Orange Door, rather than attempting to acquire these practice skills.

The evaluation found that working with perpetrators to reduce risk is an emerging area of practice. Practitioners who work within this speciality acknowledged to evaluators that their area of practice is maturing and lacks the level of evidence to inform practice to the same degree as practice areas of child wellbeing and practice with victim survivors.

The evaluation found mixed evidence of the workforce improving their capacity to work with perpetrators of family violence to reduce risk. There is some evidence of skill and knowledge sharing across teams, learning from practitioners who work in this space, and early induction training provided some overview of this practice area to all staff. However, the evaluation also found that some of the workforce (commonly those who work within a victim-survivor speciality) found the concept of working with perpetrators challenging to reconcile with their own perspectives on risk and response, and expressed to evaluators their apprehension about building their capacity to work with perpetrators (either because they did not currently have the skills to do this or because they found it difficult to understand how they could reconcile this with their practice ideology).

In terms of structural and system supports, the capacity for The Orange Door workforce to recognise and respond to family violence is supported by systems and processes of risk assessment. The Advanced Family Violence Practitioner role is a key support for staff to recognise and manage family violence however the workforce perceives this role as related to victim survivor practice rather than perpetrator practice. In the context of an emerging field of practice of working with perpetrators, and the significant innovation of including perpetrator services within The Orange Door, the absence of clear practice leadership for perpetrator services was noted. There is some evidence that in some areas, the most experienced staff in the specialty of perpetrator services are, in the absence of a formal role, assuming responsibility for practice leadership in perpetrator services for The Orange Door.

Capacity for recognising child vulnerability

At the time of field work, The Orange Door staff working with child wellbeing cases did not yet have a standardised risk assessment tool and as such, had developed localised ‘Best Interests Assessment’ (BIA) tools (based on the Best Interests Case Practice Model utilised by Child FIRST Alliances). It is important to acknowledge that a standardised tool did not exist prior to the establishment of The Orange Door. Practitioners indicated that they perceived the focus of implementation efforts of The Orange Door had been on the family violence processes and procedures, and that a focus on child and wellbeing processes and procedures would occur later.

The evaluation found that most practitioners who had previously worked within Child FIRST had skills, knowledge and experience in recognising and responding to child vulnerability concerns. However, many practitioners who had a specialty in family violence victim-survivor or perpetrator services expressed concerns regarding their ability at that point in time to adequately identify risk and respond to child wellbeing concerns – particularly in the absence of family violence concerns.

In terms of structural and systems supporting capacity for identifying child wellbeing concerns, the Child Protection Team Leader and senior Child Protection practitioners provide a key support for The Orange Door workforce in supporting the identification and response to child wellbeing concerns. However, the absence of a standardised risk identification tool for child wellbeing cases across The Orange Door areas was reported. For these staff, working with an assessment tool for child wellbeing was a new experience and most expressed their view that induction and training provided by The Orange Door at that stage was not sufficient to allow them to feel confident in risk identification for child wellbeing cases (in the absence of family violence).

It is important to note, the evaluation also found early signs of collaboration and multi-disciplinary working that was informally building the skills of the workforce in identifying and responding to child vulnerability concerns. Colocation and ability to partner for home visits for child wellbeing cases with the community based Child Protection practitioner or other staff with expertise in child wellbeing was contributing to upskilling staff who had not previously worked with children. This is a positive finding given the very early stages of The Orange Door establishment.

Training and support

Workers enter The Orange Door with pre-existing skills, knowledge and training. In this context, it is to be expected that the workforce will have variable skills. The focus of the evaluation was on training and support provided to the workforce by FSV or agencies once they had entered The Orange Door (as opposed to profiling all training previously undertaken by individuals).

There was an expectation expressed by FSV staff and practitioners that professional development specific to practice would be provided by the employing home agency. However, the evaluation found that team based reflective practice opportunities (in comparison to professional development) as an Orange Door team were not available in the early months of operations. There was an expectation from practitioners that this would be provided at The Orange Door rather than through employing agencies. It is our understanding that opportunities for reflective practice have now commenced.

Evidence from fieldwork indicated the following:

• The workforce reported that orientation and induction training provided did not adequately meet their needs. While many practitioners indicated that the induction training was a starting point and acknowledged the importance of understanding the role of perpetrator services in The Orange Door (in particular), given this emerging field of practice and the innovation of bringing this service together with victim survivor services, more detailed training was needed. At the point in time, the evaluation found that the initial induction training had not clarified understanding of how integrated practice was intended to be operationalised at The Orange Door.
• Training was pitched at a low level for their own specialty and individual skill level and did not provide the workers with sufficient understanding of disciplines outside of their area. For example, many practitioners commented that the two hour training on perpetrator practice was inadequate to assist them to understand the practice framework and ideology of these services. This was considered particularly important when the practice is fundamentally different to their own. We understand that FSV is refining the Induction Training program based on findings from their evaluation, including more comprehensive training on each of the discipline areas, [5] and undertaking a participant profile ahead of training in order to understand the level of experience in the room. Consideration will need to be given to the challenges in releasing staff to undertake large amounts of training whilst still delivering services. The workforce sought more in-depth and tailored induction and training to meet their initial orientation needs when entering The Orange Door.
• A one-size-fits-all approach to training will not work. Client Support Officers did not think that induction training was appropriate for the work they do, and was instead tailored for practitioners. They felt there was an absence of content that was directly relevant to their role and could equip them with the necessary skills for working at The Orange Door. For example, there was no training on dealing with agitated clients or engagement techniques, which they considered critical for their specific responsibilities.[6] These topic areas were expected by workers to be covered (either in induction or in other FSV initiated training) as they related directly to their roles at The Orange Door.

At the point of fieldwork, there was some evidence that some areas were in the early stages of planning a schedule of training and professional development for the workforce at The Orange Door (to be delivered through a combination of FSV and partner agencies. This will be supported by current work by FSV on a workforce strategy. As such, findings relating to training and induction need to be understood as being part of the very early stages of implementation of The Orange Door. There is a need for service to be embedded further prior to understanding in detail the specific needs for structured training and professional development.

Key finding 48:

As perpetrator services is an emerging field of practice, increased leadership in this practice may be required in The Orange Door to build the capacity of the family violence and child wellbeing workers to identify and respond to risk of violence being perpetrated

Key finding 49:

The TRAM provides a standardised tool to support the workforce to identify and respond to risk of family violence. The Orange Door does not yet have a standardised tool to support the workforce to identify and respond to child wellbeing risks (nor was one in existence prior to the establishment of The Orange Door)

Key finding 50:

The workforce seeks: more detailed and tailored induction tailored to their speciality backgrounds; more knowledge and understanding of the integrated service model; and more knowledge and understanding of how to work with perpetrators from perpetrator services.

To what extent does The Orange Door workforce have the skills to meet the needs of diverse client groups (eg Aboriginal, CALD and LGBTI clients)?[7]

The Orange Door Service Model identifies the need for a system to be able to respond effectively and safely for all Victorians, inclusive of their diverse characteristics and intersectional considerations.

In terms of the workforce’s capacity to meet the diverse needs of Aboriginal and Torres Strait Islander clients, the role of the Aboriginal Practice Lead provides a key resource to build the skills of The Orange Door workforce through collaborative practice. The evaluation does not have evidence to determine if the FTE resourcing for these leadership roles is sufficient to meet the current demand of cases and the need to build cultural safety practice across The Orange Door workforce.

The evaluation found varied skills and abilities in the workforce’s capacity to meet the needs of clients from multicultural backgrounds. Some staff brought a background and previous training on working with clients from multicultural backgrounds to The Orange Door, and there was some evidence of working with partner agencies and other localised multicultural specific services to assist tailoring of service to multicultural clients (for example, referring to a service where there is a staff member with the same language as the client). Training for working with multicultural clients and training on intersectionality had not been provided to The Orange Door workforce at that point in time either by FSV or systematically to the workforce by any partner agency.

The evaluation was unable to determine the workforce’s capacity to meet the diverse needs of clients with a disability, people from LGBTIQ communities and older people in this early stage of The Orange Door operations. Practitioners were unable to identify clients with these diversity characteristics during interview and data reporting is not possible via the CRM at this point in time. It is our understanding that FSV is currently progressing work to support workforce capability in intersectional approaches and this will include for the workforce of The Orange Door.

In terms of the workforce’s capacity to meet the diverse needs of children and young people, including young people who themselves are perpetrators of family violence, there was evidence that those practitioners with a speciality in child wellbeing brought to The Orange Door considerable skills and expertise to work with these clients. An overview of working with children and young people had been provided to The Orange Door workforce through induction training.

Case example from clients interviewed for this evaluation

Feedback from the six client interviews did not provide significant detail on the workforce’s ability to meet the needs of diverse clients. One client interviewed stated that they were satisfied with the cultural programs that The Orange Door had referred them to. In a discussion of cultural programs, the client identified the need for The Orange Door to have in place strategies to protect client confidentiality. In this case some of the people that the family interacted with at the cultural programs were connected to (either through the kinship system or their community of residence) the violent ex-partner/father of the participant and their children. The client stated that they were satisfied with how The Orange Door and other workers sought to protect the family’s privacy.

In looking forward towards increasing the skills of the workforce to meet the needs of diverse client groups, the evaluation found that clear expectations need to be conveyed to the workforce about assigning responsibility to provide training and professional development. Whilst responding to our diverse community should be any employing organisation’s responsibility, and FSV staff indicated a belief that this was indeed the responsibility of employing agencies, many practitioners expressed a view that FSV needs to provide training to all Orange Door workers to ensure a consistent and baseline level of skills across the workforce.

Key finding 51:

The evaluation was unable to determine with certainty if The Orange Door is meeting the needs of diverse client groups at that point in time. Further investigation and validation is required through client feedback

Key finding 52:

Clarity is needed for the workforce on who should provide training and professional development to meet the diverse needs of The Orange Door clients

[1] FSV, ‘Support and Safety Hubs: Interim Integrated Practice Framework’, April 2018, p36.

[2] FSV, ‘Support and Safety Hubs: Interim Integrated Practice Framework’, April 2018, p45.

[3] Qualitative evaluation data from fieldwork

[4] Qualitative evaluation data from fieldwork

[5] The Orange Door Induction Training program evaluation recommended that the family violence, victim survivor and perpetrator training, and working with vulnerable children and families training be extended to one day each

[6] For example, critical incidence training

[7] We have retained the language agreed to in the Evaluation Framework for this evaluation for the evaluation questions – however noting that the FSV nomenclature has now been confirmed to refer to ‘multicultural’ and ‘LGBTIQ’ which is now referred to in the discussion.