This submission is making a more cynical perspective is that any attempt to establish a Quality Assurance Framework will fail in New South Wales. There are too many vested interests, which will mitigate against any the introduction of such a framework. The major resistance will come from the larger multi-sited agencies, if the experiences associated with the granting of an industrial award are an guide. This will range from the large traditional charities, to the untrained and unskilled worker in the field, who has been doing the same job the same way for the past 20 years.
The quality framework in the NSW context if administered by Government will be more imaginary than real. The current approach adopted by the NSW department of Communities has had no real impact on service delivery on the few services I have had contact with. Having observed the way SAAP has been managed and implemented over the past 30 years; there is a serious reservation that the NSW Government has the capacity let alone the expertise to understand the broader issues involved.
If the NSW state plan is an indication of the future direction of the development of Homelessness service delivery, what is shown is that sectional concerns dominate. The commissioned research from AHURI also reflects sectioned bias There is no overall vision that encompasses the all the various players involved.
The NSW Government has every few years marginalised SAAP programmes to the extent; the bureaucracy does not have the necessary internal skill sets to implement any policy dealing with homelessness. The SAAP unit has been disbanded on several occasions. The number of policy staff has ranged from approximately 100 to 2 persons. It is against this background, if would not be an appropriate or effective use of resources if the NSW Government was changed with the responsibility to implement a Q A framework.
The quality framework has three levels that should underlie any system.
- Service delivery: does the current staff employ have the necessary skills to deliver a client focused service? Are their skills or competencies sufficient to meet those of the Diploma in Community Services (Case Management) CHC50902 or CM 001-2008 National Standards of Practice for Case Management? It would be desirable to have a national accreditation register of Homeless workers on the same lines as nurses, radiographers or doctors.
- The agency setting, practices and procedures, especially documentation standards employed that is client centric, not worker centric. That the agency demonstrates they are active players in the local community.
- The policy and governance level where there are objective measures showing that policy development involves all players not just the elite of the agency.
[ top ]
An online conversation about defining case management
I have been researching the issues associated with case management, as some examples I have seen in some services would be effective in a Victorian era poor house but perhaps not today. Whilst it is in the funding agreement for most services to provide case management, there does not appear to be any process of evaluating the quality and appropriateness of service delivery. The SAAP data collection has limited value in this situation
Perhaps there is a need to establish some criteria for case management practice in term of:
Core staff competencies'
Meeting Australian National Standards of Practice for Case Management CM 001-2004, CM 002-2004 and CM 003-2004
National and State based accreditation programs where accredited services are funded an additional amount for meeting such standards or those service who do meet such standards have their funding adjusted accordingly
Hello - I am one of the site administrators - thank you for starting this discussion brianadr. I think it is a really important discussion to have and to get right.
If good case management can offer a holistic approach - surely it relies on good case management practices AND people understanding exactly what case management is and means for their organisation and the people they work with.
As someone who is researching the issue brianadr where would you start - do you have some definitions/criteria for the areas you have raised.
Also we have a section on case management on the site - if you have any relevant resources - even if they show how outdated knowledge is it will generate discussion.
Thanks for you post and I look forward to your reply - for others reading this post that have an opinion/insight please weigh in to the discussion!
[ top ]
I'm wondering what the concrete experience is of workers in trying to implement case management in SAAP services. What are the challenges? What are the impossibilities? Are people using alternative models to the SAAP Case Management Kit?
A question one must ask is what is the role of Case Management?
Is it a mechanism of social control to ensure client conformity to the particular agency ideology?
Or is it a process of enabling client self determination?
This is indeed an important topic and one that I think would benefit from more discussion.
I have been involved in developing a standard case management approach for number of Adult Accommodation services in Sydney which I would be happy to share once it has been ratified. The process was probably more important that the end product so happy to discusds that as well. Thanks for raising the topic!
This is a big subject and will likely grow as the White Paper rolls out into policy and practise at the local level.
Lessee; Case Management is a term touted by policy makers variously as a panacea to a Best Practise. Various definitions are used.
Agencies nearly always have their own slants on what CM means within their organisational context. it doesn't always match the standards in, say the SAAP CM kit.
CM is always impacted by agency policies, legislation (ranging from OH&S, Privacy, Duty of Care etc), by funding body policy and demands and, at the coal face, it is profoundly impacted by extant infrastructure. A definition should be something that can still be meaningful under these influences.
Finally, and most importantly, Case Management is about the client. This sounds OK, but it somehow needs to address issues about how to be client cantered and able to be meaningful in contexts where the client's wishes/ demands do not match their needs. I understand that we all know that we need to deal with delusional demands etc, it's just that sometimes the supporting documentation doesn't seem to recognise just how much we have to work with clients to get them to a place where useful assistance can be provided. A previous post mentioned 'social control'. Sometimes I have heard terms like that one (I don't think the person who posted it meant this) used in ways that make you wonder if it's ok to steer a client away from their desire to get a house to grow pot in. (a request made to me last week)
Thanks for your thoughts. Yes, I think there always is that dilemma between being client centered and thinking about your professional duty of care and that you must might have some insight that the client doensn't have and maybe that's what the client is looking for anyway. I also get concerned that case management can sometimes drift into case coordination as in getting other organisations to do the work.
[ top ]
Just to let you know we have just posted a research report from AHURI on the site - titled: 'What makes case management work for people experiencing homelessness?' - please post any comments, thoughts etc on the forum or using the comments tool under the article.
An Interesting and really valuable topic. Where did these terms come from and what do they 'really' mean? I often wonder whether we need to break it down a little further. The term CM is often used across services and sectors and yet there isn't any uniformity on what it really means or what is involved within the role of a CM. CM tend to make me think 'clinical' CM and yet other non clinical services tend to use it to identify themselves too, but understandably as noted in the posts, for others it means something quite different. It can get very confusing. As stated in a previous post CM can sometimes become 'coordination' ie referring to other services. Maybe one way to help define what the role of a CM is to ask service users/consumers of services to explain what they understand the role to mean to them across the sectors and what do we do in that role? And in doing so identify what they may think other roles/titles mean to them across the spectrum and what services do we provide in these roles ie CM, Case Coordinator, Support Worker, Outreach Worker, Youth Worker, Community Support Worker, Rehab Support Worker, Housing Support Worker etc. We use a range of terms that we as individual organisations or sectors may understand in a particular context but what does it mean to the people we work with? So many of the people we work with cross a range of services and sectors.
The problem with the concept of the case management model is the association with homelessness and illness. There is an underlying assumption that homelessness can be cured like any sickness. This is the medical model, where the context within homelessness operates is not a primary consideration. The methodology and assumptions are based on the perceived moral failings of the homeless. They are homeless because they lack some skill which in turn has made them homeless. The role of case management is to guide the client to ensure that have acquired the necessary skills to make up for the inadequate socialisation of the person or family concerned.
[ top ]
Unfortunately, the medical model enforces the ideal of dependency on a single person, who is presumed to have a superior skill set to those of his fellow workers in dealing with clients. In small services (less than 6 workers), this an very inefficient use of man power and extremely costly approach to the delivery of services. It also dis-empowers other workers who may have well developed skill sets but may not receive the same recognition financially. Typically, in NSW, the case manager is a category three or four worker, whilst the most other staff are category two workers. If the service is inefficiently managed with staff experiencing some form of shift work, there is a high probability the case manager will also be a shift worker. This basically makes the case worker a part timer, whilst receiving a full time salary. Given the shift loadings involved a very wasteful use of limited resources. Another staff dealing with clients, in this model will not be allowed to be involved with the case management of clients. Case management becomes a very inorganic formulalistic method of client social control.
The medicalisation of homelessness should be resisted as much as possible, this be done through viewing the role of client support and empowerment a role of all the staff dealing with the client. if this approach is taken, it is easier to develop more appropriate measures to assess the impact of support given to clients over time. It becomes an organic process which is reflective of the requirements clients, not a set formula. It must be remembered SAAP services are not therapeutic services in the main. The majority of tasks when dealing with a client are fairly basic, these range from listening, problem solving and the capacity to link clients with more specialised support where required. As the role is more a co-ordination of support, a person with cert IV training would have the necessary conceptual framework to deliver services.
[ top ]
Principle 1: Services and government will work together to develop a national quality framework and accept joint responsibility for quality service provision.
Response: from having examined the data sets that are funded under national agreed programmes such as the HAAC program, there are 8 HAAC programmes not one. Each jurisdiction will place their spin on how the system is to operate. This has led to an inconsistency in program definition and execution. There is a statistical delusion we have a nation programme, the reality is we do not have a national program. What we have is a series of bilateral agreements reflection the political ethos of the ideology of both governments who are signatory to the individual agreements.
Unless there are identical enabling legislative frameworks in all jurisdictions with identical understanding and implementation regimes, and a national compliance system established with statutory independence of jurisdictional and agency influence, a national quality framework will not succeed. Any national system, must be truly national not 8 separate approaches. The quality frameworks in some jurisdictions are no more than wordplay and have no real impact as the necessary compliance systems required do not have the force of legislation, nor are they independent of the funding body. There has to be financial incentives and punishment for either compliance or non-compliance for services funded.
Principle 2: Minimising red tape will be a key consideration in the development of the national quality framework.
There will a necessity to ensure that agencies have the necessary physical system, human and financial resources to participate, for single sited and multi-sited agencies
[ top ]
Principle 3: A NQF will build on and add value to existing quality systems.
To participate in any quality assurance system will require for sufficient financial resources for system development and auditing for compliance requirements. Many of the systems are based on the documentation processes the agency uses, not necessarily an examination of the processes involved with client support.
An agency can have the best documentation systems money can buy, but still have the worst work practices and attitudes. Just because an agency meets the requirements for accreditation on paper, does not mean it is providing an appropriate quality service to clients. There is a need to ensure that both the subjective and objective measures used in any quality framework reflect the client outcomes obtained.
Principle 4: There will be a supportive and enabling approach to implementation.
Based on observation of other national programmes subject to bilateral agreement, it will not be possible to a nationally consistent approach if left to individual jurisdictions. The support and implementation process has to be coordinated by a single national body independent of jurisdictional influences both state/territory and commonwealth. The independence of this national body must have a legislative basis at both levels of government. The organisational culture in many agencies will be antagonistic towards the implementation of any attempt to change agency practices. If the compliance rate for the SAAP data collection is taken as a guide, there will significant passive resistance to the implementation of any change to agency practices.
[ top ]
Quality service provision is:
- Respectful to the client irrespective of age, gender, sexuality and gender identity, religion, race, language, country and culture of origin and for the consumer's relationships and networks;
There are three domains of cultural competence, which must be addressed. The first is service delivery. The second is service management and the third is policy development. Cultural competence is not just having a few persons attend training (though this is important), it is the policy setting and practice within the agency and broader agency context, especially multi-sited agencies, the recognition of spaces for religious observances or personal privacy, the capacity of the agency to ensure culinary practices are appropriate a changing client group and the need to ensure that essential literature relevant to the client is in a format able to be understood by all clients regardless of their English language skills. There are few if any agencies in Australia that actually meet the first criteria. The later criteria are delusional at best.
Whilst it is the policy intention of the various jurisdictions to have all services to be culturally competent, there is no objective measures defined in accessible policies in which effective benchmarking can be undertaken. In practical terms, there is a single world view (Anglo-Centric) driving the development of homelessness policies and service development, other perspectives have been either excluded or ignored in the policy discourse. The relatively low participation of persons from a CALD background in the utilisation, management and policy development aspects of homeless services is reflective of this dominant worldview.
- Delivered by a competent, trained and qualified workforce;
There has not been any discussion on what exactly this means. There is a need to have all existing sections and future workers skills sets assessed against an agreed framework defined within the context of the Australian Qualifications Framework depending on their role and function. It must be essential if a staff member be employed that their skill set is assessed independently of the agency assessment. Once a person has been certified, the period of the certification is only for three years. An ongoing system of occupational development needs to be established similar to those of other occupations. This should be a requirement of agency funding, that staff have to be either achieving the necessary current certification or be involved in an approved post certification occupational development programme. There is a need for national registration programme for homeless workers on the same lines as that other occupations have such as law, para-medical and some of the trades There are many agencies that have employed staff with either an inappropriate skill set or a sub standard skill set below that required for a particular position or role.