Questions from the Discussion Paper
1. Quality Service Provision
- Professional, objective and outcomes focussed;
- Responsive and timely and relevant to the need of the client;
- Rights based, ethical, fair and equitable;
- Enables the client to participate in the decision making process and supports them to make their own decisions and achieve goals;
- Encourages clients to participate on a broader scale within the organisation by providing feedback re service provision and evaluation, submitting complaints and appeals and participating in other avenues as available;
- Respectful to the client irrespective of age, gender, sexuality and gender identity, religion, race, language, country and culture of origin, and (dis)ability including mental health issues and mental illness and for the consumer's relationships and networks;
- Delivered by a competent, trained and qualified workforce which has access to skilled supervision and a focus on practice reflection and development;
- Supported and enhanced through collaborative partnerships and networks with similar and allied service providers;
- Provided by organisations that have strong governance, organisational and financial management processes and systems in place;
- Is informed and guided by the review, evaluation and ongoing development of practice, programs, policies and procedures
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a) What is needed in a NQF to take into account the scope and diversity of service responses across Australia and to ensure these are maintained?
- An NQF needs to be informed and developed through the understanding of diversity; the use of a diversity lens. This is not an 'add on'; it is a starting point for consideration and an integrated component of an NQF.
- In relation to women and their children experiencing and leaving family violence, the opportunity to employ an additional gendered lens and understanding of homelessness and quality is critical. The use of this lens and informed understanding is relevant not only to family violence organisations but to generic homelessness organisations who work with, or have contact with, women and their children experiencing family violence. So, with a gendered and diversity lens, quality would be assessed in relation to the services provided to and received by indigenous women, women from culturally and linguistically diverse backgrounds, older women, women with mental health issues and mental illness, women with disability and women and their children from other backgrounds and experiences.
- Sufficient flexibility in standards to ensure different services and organisations can respond to standards in ways that reflect and take into account their core business and the unique, though similar, nature of the organisation/service provided by them.
- A clear acknowledgement of the services and organisations that are included in an understanding of 'homelessness'. This includes Family Violence organisations.
b) Do you agree with the characteristics of quality service provision outlined above?
Please see the additional characteristics added.
The words and terminology that are used in standards need to be clearly defined and understood. For example, in dot point one above, what do the words 'professional' and 'objective' mean? Standards need to be clear and their meaning relevant to, and informed by, those engaging in the practice to be assessed, whether this is operational or governance.
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c) What other key characteristics or elements should be included to describe quality service provision?
- An approach that builds on existing strengths and the processes of continuous quality improvement (CQI) undertaken by Family Violence and homelessness organisations - even if these are not articulated as such in early days.
- The ways in which outcomes for clients can be strengthened and maximised according to client needs, wishes and goals.
2. Mainstream and allied services
a) How can mainstream and allied services be encouraged and supported to identify and respond to people who are homeless or at risk of homelessness?
Whilst not tied to accreditation** and having a focus within the family violence service system rather than the generalist homelessness service system, the development and implementation of the Victorian Family Violence Risk Assessment and Risk Management Framework (the Common Risk Assessment Framework, CRAF) across a range of sectors provides a good example of the processes, working relationships and communication strategies required when introducing and establishing new practices into mainstream and allied services.
Factors that contributed to the success of the introduction of new processes and practices included:
- the resourcing of the project
- the collaborative working relationships
- strong communication and feedback regarding progress between all parties and sectors
- the provision of targeted, solid and informed training for workers
- a coordinated approach to the rollout of the project across the state using people in key regional positions.
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Factors such as these are identified in the Victorian Homelessness Assistance Service Standards (HASS) and the Quality Improvement Council (QIC) standards that refer to the ability and capacity of organisations to develop and sustain external quality relationships through, for example, the development of service agreements, partnerships and integrated networks, collaboration and strategic positioning, and community and professional capacity building.
From a Family Violence perspective, mainstream and allied services need to be encouraged not only to identify and respond to people who are homeless or at risk of homelessness, but a gendered analysis (as noted in section 1) and an understanding of women and their children experiencing and leaving Family Violence needs to be held. This provides an understanding of the impact and consequences women and their children face, not only from the family violence, but from engaging in and attempting to have their needs met within the generalist homelessness service system.
** Reference to the CRAF is included in the Victorian Homelessness Assistance Service Standards (HASS). For the purposes of accreditation, it is noted as a guiding document for practice, (specifically assessment) in relation to generalist homelessness services working with people who have experienced family violence. The HASS recommended that services employ the CRAF in their work when needed and document evidence of doing so in assessment journals. However, anecdotal reports indicate that this has not occurred in all organisations. This gap points to the need for personnel in the accrediting body to have informed knowledge and understanding of the sectors within which they undertake reviews.
b) What quality approaches support stronger cross sector service integration and improved service delivery?
The factors noted above provide good starting points.
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3. Potential components of a national quality framework
Consumer charters set out the rights and responsibilities of consumers and are an integral component of any NQF.
Service charters are public statements about the services that are provided and what consumers can expect from that service.
Alliance models involve a commitment between different organisations (including mainstream, allied and specialist services) to communicating regularly and working together for the benefit of vulnerable clients.
Complaints management systems assess, manage and respond to consumer concerns and contribute to improved quality service provision.
Standards describe the expected outcome, processes and performance and can clarify expectations around service delivery. Standards can cover different aspects of an organisation's business and generally cover service delivery as well organisational management and governance practices.
Accreditation is a quality measurement framework. Accreditation is a standards based recognition system that can use a quality assurance and/or a continuous quality improvement approach. It involves assessment against a pre determined set of standards and formal acknowledgement of achievement of expected performance against those standards.
Quality assurance (or minimum quality) can be described as a process of determining whether services meet expectations. It is very much a process driven approach that defines expectations and requirements and verifies that those requirements have been met.
Continuous quality improvement (CQI) is an approach to quality that builds on traditional quality assurance methods by focussing on organisations and systems. CQI emphasises the organization and its systems and is an ongoing cyclical process of self assessment, performance improvement and review.
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a) Which of these components could be considered in a national framework?
b) Are there other key components that should be included in a NQF?
- Consumer charters are vital to ensure that consumer rights, responsibilities and participation are enacted and made real in organisations.
- Significant work has been undertaken by the sector in implementing a continuous quality improvement (CQI) focus into their organisations and, indeed, into organisational culture. Within the Family Violence sector, a focus on reflective practice has encouraged and enabled many organisations and practitioners to articulate a broader understanding of practice review, development and quality and so adapt CQI into a model that is relevant to them. Hence, a CQI focus is considered by the sector to be more desirable than the time-limited, task-focused quality assurance.
- Recognition of existing key guiding documents that are employed by the sector and the roles these documents play in identifying, articulating and encouraging leading, reflective and informed practice is crucial. Despite the low levels of funding within the Family Violence sector, it is a sector that has developed, and has contributed to the development of, key guiding documents and research. Primarily, these documents concentrate on practice reflection, development and improvement with the ultimate positive outcomes occurring for women and their children experiencing and/or leaving family violence. Another outcome from these documents and their use is the development and refinement of the skill base of the workforce.
Relevant Victorian documents include the Domestic Violence Victoria Code of Practice for Specialist Family Violence Services; Practice Guidelines: Women's and Children's FV Counselling and Support Programs; and the aforementioned Family Violence Risk Assessment and Risk Management Framework. Vital research that informs practice, and therefore practice that is assessed against accreditation standards, includes Researching the Gaps: The Needs of Women who have Experienced Long-term Domestic Violence, (Healy, L., 2009, Good Shepherd Youth and Family Services & Mornington Peninsula Domestic Violence Service); and Building the Evidence: A report on the status of policy and practice in responding to violence against women with disabilities in Victoria (Victorian Women with Disabilities Network, 2008).
4. How would a NQF relate to existing state and territory quality systems?
a) What currently works well in ensuring service quality in your state or territory?
Please refer to the Council to Homeless Persons Submission Paper
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5. Other quality frameworks
a) What lessons can we learn from existing quality frameworks?
b) What would you change in existing quality systems to improve outcomes for people experiencing homelessness?
- All aspects of quality frameworks, whether it be their development, trial, implementation or evaluation, require adequate resourcing in terms of cost, quality, time and personnel.
- The Family Violence sector has undertaken an enormous amount of work in assessment and development of practice, processes, policies and procedures in operational, leadership and governance components of organisations. Achieving accreditation has been a significant accomplishment for organisations and for the sector. Whilst organisations have identified the hard work and other disadvantages involved in working toward accreditation (eg, lack of extra financial resources to support backfill and the creation of co-ordination roles; attempting to continue providing a service to women and their children throughout the time demands of accreditation), they have also identified the benefits and the learnings that have occurred.
- Consequently, a NQF would need to take into account the standards and benchmarks by which Victorian Family Violence organisations are currently accredited. Work already undertaken must be recognised and built on.
- Within standards and the ways in which they are assessed, there need to be clear links between quality and practice, whether operational, managerial or governance. For example, how do standards effectively relate to and contribute to the ongoing development of the day-to-day practice of workers? This is not about including a compliance focus, as some workers had feared, but, again, a continuous quality improvement and developmental focus.
- Including a stronger focus on practices such as supervision and practice development opportunities in a NQF would contribute to strengthened links between practice and quality within organisations.
- In turn, this leads to questions about workforce development. For example, what training is available for workers to enable them to continually build on their skills and knowledge? What options for supervision are there for workers at beginner, intermediate and advanced levels of practice? Possibilities for discussion about these issues are raised in the HASS and/or QIC standards through, for example, incorporating and contributing to good practice, and monitoring the outcomes of service delivery practice. There must be recognition that when gaps or requests for further development are raised by particular standards, that there will be accompanying questions about resources available to meet the improvements that have been indicated as needed.