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Prepared for Mary O’Loan
Access Centre Manager
The consultant would like to thank the following persons who assisted in the compilation of the study. Firstly, Frances Chance, formerly Principal Social Worker in Community Area 7 was responsible for the development of the initial project concept. In taking this initiative, he showed considerable foresight. Frances Chance is now a regional director with Barnardos. Mary O’Loan and her staff, Shirley and Anita, are to be congratulated in pursuing the project’s development with dedication and commitment. Thanks go to Principal Social Worker Carol O’Flynn and Child Care Manager Colman Duggan, who oversaw the project over all the stages outlined in this document. The study would not have been possible without the generous participation of the parents, foster carers and children who are the customers of the project. In particular, the children were most cooperative and tolerated research inquiries with equanimity. Many thanks also go to the social workers that responded to requests for information. The consultant hopes that this document will be of value to those developing access centres in other areas. Coinneach Shanks Virtual Image Research Consultants
ACKNOWLEDGEMENTS ........................................................................................2 CHAPTER 1: 1.1 1.2 1.3 1.4 1.5 1.6 1.7 INTRODUCTION............................................................................7
INTRODUCTION .....................................................................................................7 THE EVALUATION PROJECT CONTEXT. ................................................................7 PROJECT ENQUIRY COMPONENTS ........................................................................8 MODEL EMPLOYED ...............................................................................................8 THE SCOPE OF THE STUDY ....................................................................................9 TERMS EMPLOYED IN THIS STUDY ....................................................................10 ACCESS CENTRE: STRUCTURE OF REPORT: CHAPTERS...................................11 POLICY CONTEXT FOR THE ACCESS CENTRE ................13
2.1 INTRODUCTION ...................................................................................................13 2.2 THE NATIONAL LEVEL - IRELAND .....................................................................13 2.2.1 SUMMARY OF HEALTH BOARD RESPONSIBILITIES .............................................13 2.2.2 IDENTIFIED NEED ..............................................................................................13 2.2.3 DEVELOPMENTS ..............................................................................................14 Chart 1: Likely state organisational structure for children responsibilities ..............15 2.6 THE EUROPEAN LEVEL.......................................................................................15 2.7 THE INTERNATIONAL LEVEL .............................................................................16 2.8 CONCLUSIONS AND LESSONS FOR THE ACCESS CENTRE...................................17 CHAPTER 3: THE COMPARATIVE DIMENSION. .......................................19
3.1 INTRODUCTION ......................................................................................................19 Table 1: Case study display ......................................................................................19 3.2 CASE STUDY 1: AUSTRALIA AND NEW ZEALAND.................................................19 Table 2: Vigilance levels display..............................................................................20 3.2.3 PRINCIPLES .......................................................................................................21 3.3 CASE STUDY 2: THE UNITED KINGDOM ............................................................22 3.3.1 CONTEXT .........................................................................................................22 3.3.2 USAGE ..............................................................................................................22 3.3.2 GUIDELINES FOR USE ........................................................................................22 Table 3: Contact guidelines display.........................................................................23 3.4 CASE STUDY 3: UNITED STATES.........................................................................23 3.4.1 CONTEXT ..........................................................................................................23 Table 4: Visitation plan standards display ................................................................24 3.5 CONCLUSIONS AND LESSONS FOR THIS PROJECT...............................................26 Chart 2: The visitation flow in current practice ...........................................................27 CHAPTER 4: 4.1 PHASES OF DEVELOPMENT ...................................................28
4 4.2 PHASE 1: THE INITIAL IDEA AND PROPOSAL ....................................................29 Table 5: Visit stages display ....................................................................................29 4.3 PHASE 2: DEVELOPMENT PERIOD FOLLOWING THE APPOINTMENT OF THE ....30 COORDINATOR ............................................................................................................30 Table 6: Original position of access work in Community Area 7 display................31 Table 7: Anticipated remedial intervention display.................................................31 4.4 PHASE 3: APPOINTMENT OF MANAGER ............................................................31 4.5 PHASE 4: OCCUPYING THE PREMISES................................................................32 4.5.1 INTRODUCTION .................................................................................................32 4.5.2 THE BUILDING AND PHYSICAL RESOURCES ......................................................32 4.5.3 STAFF................................................................................................................33 Chart 3: Current Organisation of the Access Centre ................................................34 4.5.4 SYSTEMS ...........................................................................................................34 4.6 PHASE 5: OPERATIONAL COMMENCEMENT ......................................................34 4.6.1 THE PREMISES IN USE ........................................................................................35 4.6.2 TRANSPORT.......................................................................................................35 Table 7: Transport criteria display............................................................................35 Table 8: Travel and supervision time display ...........................................................36 4.6.3 BOOKINGS .........................................................................................................36 Table 9: Bookings and completed hours display ......................................................37 4.6.4 CANCELLATIONS ...............................................................................................37 Table 10: Cancellations by year display ...................................................................38 Table 11: Non-attendance analysis display...............................................................38 4.7 PHASE 6: PLANNING AND OCCUPATION OF THE PURPOSE BUILT CENTRE ......40 4.7.1 THE NEW SITE ...................................................................................................40 4.7.2 THE PHYSICAL ENVIRONMENT...........................................................................41 4.7.3 INTERIOR OF THE NEW BUILDING.......................................................................42 4.7.4 ENTRY TO THE PURPOSE BUILT PREMISES ..........................................................43 4.8 CONCLUSION AND OBSERVATIONS .....................................................................43 4.9 CRITICAL INCIDENTS ..........................................................................................44 4.9.1 TECHNIQUE .......................................................................................................44 4.9.2 CLIENTS WITH ADDICTION PROBLEMS ...............................................................44 4.9.3 CLIENTS WHO ARRIVE UNDER THE INFLUENCE OF ALCOHOL AND DRUGS ..........45 4.9.4 CLIENTS WHO ARRIVE AT THE CENTRE ACCOMPANIED BY UNAUTHORISED PERSONS:.......................................................................................................................45 4.9.5 FAMILY MEMBERS WHO “ACT OUT” WITHIN THE CENTRE .................................45 4.9.6 THEFT ...............................................................................................................45 4.9.7 LESSONS ...........................................................................................................46 4.10 FLOWCHARTS ...................................................................................................46 Chart 4: Current Access Referral flow.....................................................................47 Chart 5: Access Centre Project - phases of development .........................................48 CHAPTER 5: APPLICATION OF A CONSUMER MODEL...........................49
5.1 INTRODUCTION ...................................................................................................49 Table 12: Consumer-orientated indicator system ........................................................49 5.2 INDICATORS IN CONTEXT:..................................................................................49 5.3 INDICATOR 1: ACCESSIBILITY ...........................................................................50 Table 13: Criteria for the exterior of the building display ........................................52
5 Table 14: Criteria for the building interior display...................................................53 5.4 INDICATOR 2: CHOICE .......................................................................................53 Table 15: Improvement criteria display....................................................................54 5.5 INDICATOR 3: VOICE ..........................................................................................55 5.6 INDICATOR 4: ACCOUNTABILITY.......................................................................56 5.7 THE PURPOSE BUILT PREMISES: ACCESS ...........................................................57 CHAPTER 6: PROVISION 6.1 6.2 6.3 6.4 SYNTHESIS –AN ASSESSMENT OF QUALITY IN 59
INTRODUCTION ...................................................................................................59 PROVISION OF USER-ORIENTATED SERVICES ....................................................59 PROVISION OF QUALITY SYSTEMS THAT ARE FLEXIBLE AND ADAPTABLE ........61 PROVISION OF SYSTEMS THAT TAKE INTO ACCOUNT THE DIFFERENTIAL NEEDS OF USERS ......................................................................................................................61 6.5 PROVISION OF FRAMEWORKS THAT RESPOND TO ORGANISATIONAL FLEXIBILITY .................................................................................................................62 6.7 INTRODUCTION OF QUALITY THAT LEADS THE ORGANISATION, RATHER THAN COSTS ...........................................................................................................................62 6.8 ADOPTION OF PERFORMANCE TARGETS THAT ALLOW FOR QUALITATIVE AND QUANTITATIVE FEEDBACK. .........................................................................................63 6.9 DEDICATION OF TIME AND RESOURCES FOR IMPLEMENTATION OF USERORIENTATED SYSTEMS .................................................................................................64 6.10 PROVISION OF CONTINUITY OF SERVICES AND FUNDING ................................64 6.11 ENGAGING IN PARTNERSHIPS OF SERVICE PROVIDERS ...................................64 6.12 DEVELOPMENT OF A CULTURE OF INNOVATION, RESPONDING TO NEED AND REQUIREMENT .............................................................................................................65 6.13 ENGAGING OF HIGHLY QUALIFIED STAFF ABLE TO RESPOND TO USER NEEDS AND DEVELOPMENT .....................................................................................................65 6.14 INVESTMENT IN TRAINING AND TRAINING PARTICIPATION OF WORKERS ......66 6.15 ENSURING EQUAL OPPORTUNITIES BETWEEN MEN AND WOMEN ARE NOT NEGLECTED ..................................................................................................................66 6.16 CONCLUSION ....................................................................................................66 Table 16: Assessment of quality in provision – summary display ..........................67 CHAPTER 7: FUTURE DEVELOPMENTS.......................................................68
7.1 INTRODUCTION ...................................................................................................68 7.2 PROCEDURES AND PROTOCOLS [A]....................................................................69 7.2.1 REORGANISATION .............................................................................................69 7.2.2 TRANSPORT.......................................................................................................69 7.2.3 ORGANISATIONAL INTEGRATION.......................................................................70 Chart 6: Proposed organisational structure for access work ....................................70 7.2.4 ANCILLARY SERVICES ......................................................................................70 7.2.4 EXTENDED FAMILY VISITING .............................................................................71 7.3 PHYSICAL RESOURCES [B].................................................................................71 7.3.1 SAFETY .............................................................................................................71 7.4 STAFF RESOURCES [C]........................................................................................72 7.4.1 ACCESS MANAGER ...........................................................................................72
6 7.4.2 RECEPTION/ADMINISTRATIVE WORKER .............................................................73 7.4.3 PORTER .............................................................................................................73 7.5 EVALUATION AND MONITORING [D] .................................................................74 7.5.1 PROCESS EVALUATION .....................................................................................74 7.5.2 OUTCOME MEASUREMENT................................................................................74 7.6 DEVELOPMENT OF THE SERVICE [E] .................................................................75 7.6.1 DEVELOPMENT..................................................................................................75 CHAPTER 8: CHAPTER 9: EXECUTIVE SUMMARY............................................................77 RECOMMENDATIONS...............................................................82
APPENDIX “A”: DESCRIPTION OF SERVICE .................................................84 APPENDIX “B”: DRAFT CODE OF PRACTICE ............................................85
APPENDIX “C”: PARENTS’ QUESTIONNAIRE...............................................88 APPENDIX “D”: FOSTER CARERS’ QUESTIONNAIRE................................94 APPENDIX “E”: SOCIAL WORKERS QUESTIONNAIRE.............................100
Definition of the Access Centre: A centre through which parents may meet their children who have been placed into care and where external professional supervision is necessary, such that enduring familial ties, parental and social skills may be developed in a positive atmosphere of safety and support.
1.2 The evaluation project context. The Access Centre evaluation commenced in 2000 and continued over its period of introduction. At the outset, research questions were framed in the likelihood that the centre would be operational within a year. However, various unforeseeable problems arose during the implementation period. These will be covered later in this report. The implementation period expended over a considerable period necessitating a reframing of the evaluation project. Staff members and consultant agreed that the evaluation project adopt an alternative orientation whilst retaining the original enquiry methods. The project reoriented to provision of a watching brief. This brief covered the period of introduction, acquisition of temporary premises, operationalisation and the relocation of the project to a purpose built premises. The evaluation spans several specific periods as follows: 1. The initial period where no dedicated premises existed. 2. The following period where premises existed prior to access visits being possible 3. A period of running the access centre whilst recruitment of staff commenced 4. The period where a minimum of two staff were in place. This period, immediately prior to relocation, includes negotiation and planning for the layout of the purpose built centre. This evaluation is therefore unusual in that it spans a long period. However, there are various advantages associated with the approach. Firstly, it offered an opportunity to examine the project from the standpoint of innovation. Secondly it offers an opportunity to provide guidelines for the introduction of similar projects. The evaluation therefore adds value in terms of offering a Vademecum element. A Vademecum (literally, “go with me”) is a European approach, which entails instruction and advice to those who follow. Using the experience offered by innovation, particularly in development and decision-making, this document aims to offer advice to those that follow the introductory process. In this manner, it is intended that other such developments may take advantage of the positive experiences encountered, whilst avoiding the pitfalls encountered in project innovation.
Project enquiry components 1. Consultation: Interviews and discussions with (formal and informal) management and key service delivery workers, foster carers, and adult centre users/customers 2. Observation: observation of centre practice; adult users and children behaviour, transport arrangements and effects 3. Self-completion questionnaires for social workers, foster carers, adult centre users. The direct engagement of service users is herein referred to as “consultation”)
1.4 Model employed The consultant utilises a formal model of assessment developed for welfare consumers. This model, developed at EU level, examines social provision from the point of view of the customer. In this case there are several different types of customers: adult centre users, children and foster carers. The model has been adapted for use in this project as follows: • Access: Recent orientation to service-users privileges the idea of “customers”, which in turn raises notions of choice. In this case customers may be seen as anyone who uses the service (and who is not a member of staff of the Health Board). Customers are adult users, the children (usually the subject of a care order) and foster carers (in the service of the Health Board but at arms-length from decision making). Access itself includes a crucial dimension of physical access. How difficult or easy is it for customers to gain access to the service at the physical level? Geographical location, available transport, approachability and any confidentiality problems inherent in the physical location all form part of this level. Choice: In the introduction of such a service there are clear limitations in choice for customers. The first constraint is a legal one. The adult users of the service are not at liberty to exercise choice in differing services. Yet there are clear personal choices available to them. They may decide on the manner in which way use the service, no matter their self-interest. They invest time and energy in using the Access Centre. The key policy objective of the Department of Health and Children is to maintain family ties between children in care and parents and is of vital importance to this study. For example, does the service encourage independence rather than reinforce dependency? Similarly foster carers are constrained by service limitations. Visitation rights impact greatly on their lives, yet they appear to have few choices as regards their implementation. Children are currently being invited to exercise more choice then hitherto envisaged. This tends to be age-appropriate. In visitation arrangements, they can and do express views – their compliance in arrangements for example may be observed. Voice: Voice is the means by which customers assert their desire to shape their own role in service delivery. Of vital importance here is their ability to influence the development of a new programme. In this case, they may have experienced different arrangements prior to the introduction of the Access
9 Centre. They are thus able to make comparisons. Foster carers often feel excluded from welfare developments - yet they are crucial to the security and well being of the child or children in their care. Their contribution is significant in the care system, especially where foster rather than institutional care is dominant. Access arrangements make a difference to their lives because they manage the preparation and aftermath of visits. Their contribution may be very specific and this is important to encourage. Children can be regarded as the end-users and the main priority in the service. Their voice tends to be neglected simply because of their age. We pay special attention to any contribution they may make even if it is not articulated in an adult manner. It may be articulated through play or behaviour. • Accountability: Accountability spans several areas. The service provider (The Access Centre) is responsible not only to customers but also to a government department and ultimately to tax paying citizens. Resource allocation falls into this category such that we must pay close attention to the appropriateness of inputs, resource use and outcomes. But ultimately the service must be accountable to children at the levels of: 1. Child protection 2. Child development 3. Future choice (as regards association with family members) • The service is also accountable to the neighbourhood in which it is located – especially since adult service users (parents) may not always be able to sustain conventional or acceptable behaviour when visiting the centre. Finally, the project is a function that services “internal customers”. In this case, social workers avail of the access service, whilst remaining accountable in the same manner as that specified above.
1.5 The scope of the study The scope of the study is necessarily wide, because of the following factors: 1. The service deals with several customer groups with differing and often conflicting goals or aspirations. 2. The service must achieve satisfaction with a variety of internal and external actors including social work staff, legal representatives, parents, children, foster carers and neighbours. 3. The service process involves not merely protection and supervision but must also operate a multi-objective system, which includes socialisation and development of children and adults. 4. The service must provide adequate staff resources to provide for supervision and observation and maintain a suitable level of organisation to enforce a range of interventions contingent with child safety. 5. The service must live with and manage the element of danger inherent in dealing with an adult client group for whom supervision is necessary. 6. The service must provide a range of physical resources and materials appropriate to the task above. This includes the necessary facilities for visits
10 such as cooking and play facilities combined with hardware such as play materials. 7. The service must be responsible for maintaining a suitable environment within which the objectives are carried out. This includes not only matters of observation and safety but of process and development. 8. The service must maintain a robust method of case recording compatible with field operations in the social service arena. 9. The service must maintain a practical ethical base, which ensures protection for a wide range of actors. 10. The service must maintain a knowledge of and conformity with best international practice. All of these factors have, as far as is reasonably practicable, been taken into account in the study. 1.6 Terms employed in this study There exist many terms for centres that accommodate the application of access or visitation rights. This will be covered in greater length later in this report. In this report, the Access Centre is the recently introduced centre/project under study. It comprises of a centre where parents who have been the subject of a Care Order may visit their children in the presence of a third party who is a representative of the Health Board. The terms “access” and “visitation” are synonymous. The latter term, more common in the US, is often used for third party visiting locations where parents are separated or divorced. In these cases, parents may be mutually hostile or have no suitable accommodation wherein to meet their estranged children. Here, parents are not necessarily suspected of domestic violence, drug abuse or other activities rendering children “at risk”. Such centres exist for the application of visits as have been permitted or ordered by a court. Such centres share the objective of providing a conflict-free visiting environment. Recently there has been an attempted replacement of the terms “visitation” and “access” by “parenting time”. This, however, appears to exclude grandparent and sibling access. Access is understood as planned contact between a child or children and his or her family with the specific aim of maintaining family relationships. In this case the access takes place where the child has been removed from its home through agency intervention, usually in the case of neglect or abuse and placed (in order of numbers placed) with: a foster carer a voluntary placement with a relative a children’s home Specifically, supervised visitation therefore refers to contact between a non-custodial parent and one or more children in the presence of a third person responsible for observing and seeking to ensure the safety of those involved. "Monitored visitation", "supervised child access", and "supervised child contact" are all terms with the same meaning (Reineger, 2000). This study will mainly refer to supervised child access.
11 In this study “the best interests of the child” refers to an overriding consideration as to how the child will benefit from interacting with his parents. Although the Access Centre seeks to improve child-parent interaction through socialisation, role modeling and development activities, the determining courses of action taken always relate to child benefit. Given the inherent lack of objective criteria, the best interests of the child are almost always determined by subjective criteria derived from the Centre’s experience, knowledge and practice on a case-by-case basis. In common with the Children Act 2001, 'relative', in relation to a child, shall mean a grandparent, brother, sister, uncle or aunt, whether of the whole blood, half blood or by affinity, and includes the spouse of any such person and any person cohabiting with any such person. Within this report, capitalisation of “Access Centre” or “Access Centre Project” refers to the project under review, whereas “access centre” (small letters) is a general reference to access, contact or visitation centres either existing elsewhere or in future developments. 1.7 Access Centre: Structure of Report: Chapters
1. The introduction deals with the scope of project. It outlines the adopted methods and approach. It additionally outlines the changes to methods that were necessitated by factors influencing changes in the planned development of the project itself. 2. This is followed by a review that places the project in context of policy and legislation. 3. A comparative dimension is introduced, which includes international experience. It introduces development of access centres in the UK, Australia and New Zealand and the United States. 4. The history and development of the project is outlined, examining positive and negative factors in organisation and development. Factors such as funding and staff resources are examined in so far as they affect the operation and development of the project. 5. The experiences and views of the key players and stakeholders are reviewed. The consumer model outlined above is applied to the clients (children and parents) necessarily examining positive and negative factors that arose during the course of development. Much of this section relies on the observation of parents and children carried out over the course of the evaluation. This section goes on to look at views and experiences of foster carers. In this case foster carers fall between clients and staff since fosterers are contracted to carry out a custodial and care role for the child at the behest of the agency. The experience of access centre workers themselves is examined, as are the views of social workers prior to introduction. This section utilises graphics and displays to offer a structured visual picture of the relationships between actors.
12 6. A thematic synthesis looks at the introduction of the access centre in a structured manner using an EU model in which various indicators are employed to evaluate quality of service. 7. The study ends with recommendations that include suggested changes in approach, improvements to the environment, liaison relationships and suggestions for extension. An operational code of practice is appended to the report.
Policy context for the Access Centre
2.1 Introduction The introduction of the Access Centre occurs within the context of services and policy in the areas of children, families, residential and fostering services and social welfare generally in Ireland. More widely, Ireland has responded to the European and international framework generally. The Access Centre works within a number of criteria covering child protection, out of home placements, and support for children and families. The context of this report falls within the remit of the Child Care Act of 1991, Section 8, Paragraph 3c, to review the adequacy of child care services. 2.2 The National level - Ireland Responsibility lies across several departments, themselves subject to change in the current period. These departmental objectives and responsibilities can be found in The Statement of Strategy 2005-2007 in regard to the Children’s Strategy. Children responsibilities are currently divided across three departments, currently working together to ensure coherence in the overall strategy as follows: 1. The Department of Health and Children 2. The National Children’s Office 3. The Ombudsman for Children Key Legislative Areas regarding residential and foster placing of children, and all arrangements thereof, fall under The Child Care Act 1991, the Adoption Acts 1988 and 1991, and the Children Act 2001. The latter is under continued implementation. A Childcare Advisory Committee was established in accordance with the Child Care Act of 1991. This committee agreed that the development of child-centred services was required to respond to domestic violence in conjunction with other supports at local level. 2.2.1 Summary of Health Board responsibilities Under the Child Care Act of 1991 it is the responsibility of the Health Board to promote the welfare of children in its area who are not receiving adequate care and protection. The Board must take such steps as it considers requisite to identify children who are not receiving adequate care and protection. It must co-ordinate information from all relevant sources relating to children in its area, having regard to the rights and duties of parents. It must regard the welfare of the child as the first and paramount consideration and in so doing must have regard to the wishes of the child, given the child’s age and understanding. It must give due regard to the principle that it is generally in the best interests of a child to be brought up in his own family. The Health Board shall provide child-care and family support services, and may provide and maintain premises and make such other provision it considers necessary or desirable for such purposes. 2.2.2 Identified need The Review of Child Care and Family Support Services of 1988 stated - as an identified need - that the time spent by social workers in supervision of access visits may not be the most effective use of their time and should be reviewed. This ongoing programme investigates a development designed to release at least part of that time and to place access in a more appropriate milieu.
Around 88% of children in care in the Eastern Health Board Region are in foster care, the majority being in long term care. The remainder are housed in residential group homes, many of them administered by voluntary agencies. The Review identified children’s rights as requiring policy development. Although this has occurred at a national level, the evidence for local implementation remains slight. 2.2.3 Developments Pertinent to the development of the Access Centre is the development within the wider community for the prevention and early identification of neglect, abuse and exploitation of children through the expansion of family support services. The strategy emphasizes that there will be full implementation of Children First1 by health boards and all organizations providing services to children. The Irish Social Services Inspectorate is to be expanded so that it can monitor the quality of all aspects of childcare services and provide guidance on standards and good practice for service providers. Treatment and counselling services will be developed to try to minimise the trauma for children resulting from abuse. A comprehensive child care information system will be developed to improve the efficiency of services at a local level and to allow evaluation of the effectiveness of services at regional and national level. Expanding and supporting foster care is based on a major review undertaken by the National Foster Care Working group. This group is reviewing domestic adoption law in the light of the recommendations of the Constitution Review Group and the conclusions of the All Party Oireachtas Committee on the Constitution. The Final Report of the Commission on the Family, Strengthening Families for Life2, published in July 1998, contained a number of policy recommendations on family life. A Family Affairs Unit was then established within the Department of Social, Community and Family Affairs with a range of responsibilities in relation to coordinating and developing policy and services to support families. The proposed overall Ireland structure for children will take the following shape:
Children First; National Guidelines for the Protection of Children and Welfare of Children, Dept of Health and Children, The Stationery Office, Sept, 1999 2 Commission on the Family, Strengthening Families for Life, Stationery Office, 1998
Likely state organisational structure for children responsibilities
2.2.5 National Children’s Strategy Finally, central to the Access Centre under study is Objective L of Ireland’s National Children’s Strategy3. This states that children will have the opportunity to experience the quality of family life. This objective also addresses the needs of children who either have no family, or are out of the family and in-state care with the aim of the providing these children with as good a family experience as is possible. This extends the task of the Access Centre beyond that of compliance with general principles of maintaining contact with parents to that of catering for the extended family of siblings, grandparents and so on. It additionally implies that the activities resources of an Access Centre should extend to areas associated with good parenting.
The European level
2.6.1 Statutes: The following conventions are important for the establishment of the Access Centre: 1. Convention for the Protection of Human Rights and Fundamental Freedoms (Council of Europe) 2. European Convention on the Adoption of Children (Council of Europe) 3. European Convention on the Legal Status of Children born out of Wedlock (Council of Europe)
Dept of Health and Children, National Children’s Strategy – Our Children their Lives, Stationery Office, 2000
16 4. European Convention on recognition and enforcement of decisions concerning custody of children and on restoration of custody of children (Council of Europe) 5. European Convention on the exercise of children's rights (Council of Europe) 6. Convention on contact concerning children (Council of Europe) The Convention on Contact concerning Children, Strasbourg, 15.V.2003 (No 6 above) ensures the right of the child to maintain contact with both parents: Article 4 sets out the procedures for contact between a child and his or her parents as follows: 1. A child and his or her parents shall have the right to obtain and maintain regular contact with each other. 2. Such contact may be restricted or excluded only where necessary in the best interests of the child. 3. Where it is not in the best interests of a child to maintain unsupervised contact with one of his or her parents the possibility of supervised personal contact or other forms of contact with this parent shall be considered.
The International Level
2.7.1 Context Various agreements, conventions and protocols exist at the international level. Signatories (nation states) are technically obliged to introduce legislation, which complies with the legislation adopted. 2.7.1 Statutes The following conventions are important for the establishment of the Access Centre: 1. Convention on the Rights of the Child (United Nations) 2. Convention on Protection of Children and Co-operation in respect of Intercountry Adoption (Hague Conference) 3. Convention on the Civil Aspects of International Child Abduction (Hague Conference) 4. Convention on Jurisdiction, Applicable Law, Recognition, Enforcement and Co-operation in respect of Parental Responsibility and Measures for the Protection of Children (Hague Conference) The international level offers more developed statements regarding children in care and family life to which the Access Centre orientates. International statute recognises that, in all countries in the world, there are children living in exceptionally difficult conditions. Such children need special consideration. Signatory states undertake to guarantee child protection and ensure that services and facilities exist for their care and protection. Furthermore, all actions concerning children, regardless of whether they are undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, shall always be in the best interests of the child as a primary consideration.
17 Under Article 9 of the UN Convention, states are held to respect the responsibilities, rights and duties of parents - or, where applicable, the members of the extended family or community- to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention. The Declaration on Social and Legal Principles relating to the Protection and Welfare of Children, with Special Reference to Foster Placement and Adoption Nationally and Internationally (3 Dec. 1986) offers general principles outlined in Resolution 41/85. Articles 1 to 8 state that any child should be in the first instance be cared for by his own parents. Where for reason of inappropriate behaviour by the parents, foster, adoptive or institutional care should be considered. The best interests of the child are paramount. Of particular importance for the introduction on the Access Centre is that for those in “out of home care such as fostering or institutional care”, the child should have knowledge of his own parents, who should be appropriately involved in matters regarding the child. Direct contact is mentioned under Article 9. This states that where it is necessary to separate the child from the parents, usually due to neglect or harm, all states must respect the rights of the child to maintain direct personal relations and direct contact with both parents on a regular basis except where it is not in the child’s best interests. 2.8 Conclusions and lessons for the Access Centre The introduction of the Access Centre lies formally within policy regarding: 1. The objectives of state care for children, with particular reference to those who are subject to a care order and are placed out of home. 2. Ensuring the rights of the child with particular reference to the maintaining of contact with their parents and to respect and encourage the rights and duties of the parents 3. The introduction of child centred services or transformation of existing services into child centred services. To a major extent, the Access Centre also seeks to assist in the normal development of the child in terms of experience. It does this through facilitation of the use of educational and play resources and also the encouragement of meal preparation. Where parents have access to their children under supervision, the overall system should seek to provide a good development experience that does not place undue strain on the child. Whatever system is in place, it should always seek to act in the child’s best interests. The introduction of the Access Centre also acts to support families in line with the broad range of legislation. Whilst it is not in a position to respond to local demand as is specified in recent policy developments, it does seek to offer development for families in terms of role modeling. Inappropriate behavior is identified and dealt with in situ. In extremis, training can be recommended in a number of specialist centres. Recent changes in Irelands demography, particularly the changes made by immigration at the EU and international levels, suggest that the question of custody
18 and inter-state travel will have an impact on social welfare. The Centre may be in a position to address the issue of abduction, so that planning can be carried out prior to any incidence of such cases. Finally, the introduction of the Access Centre seeks to release social work resources currently dedicated to supervision visits, in line with various recommendations of Department of Health and Children working parties.
The comparative dimension.
3.1 Introduction The objective of providing Access Centres for the purpose of supervised visitation has been pursued in a wide range of states in the English-speaking world. It appears to be most developed in the United States, Canada, Australia and New Zealand, in that clear guidelines exist. As far as can be determined, Australia and New Zealand exhibits the most organized, homogeneous expression of standards. The United States is typified by uneven development which may be in consequence of a neo liberal approach to service providers. However, statutory funding is now being introduced and applied by an increasing number of federal states. The United Kingdom can be regarded as being in development and as volunteer agency-led. That is, the lead has not been undertaken by the state and guidelines have been established post hoc. Within the UK however, the Scottish Executive has instituted a consultation process4 on children, which includes supervised contact. Table 1:
State NZ and Australia
Case study display
Development High: cohesive, organized, involved> Highly articulated guidelines Features Associations of contact centres. High-level state support and practitioner involvement is high Government appointed NGOs advising agencyled network. Contact centre Network appears under-developed and under-funded Charitable and voluntary sector-led and now receiving federal funding Lessons Well-developed notions of vigilance for contact centres. Well developed body of practice-based knowledge Reactive rather than proactive. Guidelines are grafted on to existing system
Medium: agency-led. Unevenly applied
Medium: Long term development period but fragmented and uneven
Despite charitablevoluntary basis, research and evaluation provides grounding for evolved standards and guidelines
In the case studies that follow, the author has selected sets of standards and protocols as providing particularly useful guidance for this project. These sets, shaded in orange below, should be considered as material for integration into Access Centre conduct. It is recognized that parts of this material have received a de facto introduction over the period of development of the Access Centre 3.2 Case Study 1: Australia and New Zealand 3.2.1 Context Australia and New Zealand began to identify the need for supervised contact at the general (separation issues) and the specialised (Care and Protection Orders) levels in
20 the mid 1990s. Child contact services have occupied an important place since they were set up as a pilot program early in 1996. Family Services Quality and Information Systems project (FAMQIS) is now a contract organisation. The funding for the contact services sub-program in 1998-99 was $1.3 million (Aus) and was set to increase by an additional $4 million each year over the following four years. The emphasis is the same as that behind the Australian Government's reforms to the Family Law Act. Resource constraints constituted the major factor in restricting the frequency, duration and nature of contact and represented a key problem in the field. 3.2.2 Management of Risk (Vigilance) The following pertains to childcare and protection. In the case of identified child risk becoming evident the child becomes subject to a care and protection order. At this stage the issue of management of contact between the child and the child's parents, siblings and relatives arises. Several levels of supervision models therefore evolved as follows:
Vigilance levels display LEVELS OF VIGILANCE – N.Z. AND AUSTRALIA
1. Low vigilance supervision: appropriate for cases where risk factors are minimal. The service may be provided on site or off site and may include supervision of changeovers or supervision of contact. The service consists of general monitoring and facilitation. The aim is to promote healthy relationships and improve or develop an ability to independently manage contact arrangements. The service may work in close cooperation with other services such as counselling services. 2. Vigilant supervision: Subject to intake assessment, this type of supervision may be appropriate in cases involving: high conflict; poor parenting; manageable abduction risk; low risk violence cases; parents with manageable substance abuse or psychological problems. The service may be provided on site or (less commonly) off site. The service may include supervision of changeovers and supervision of contact. The service aims to assist to ensure the safety and welfare of the child; to ensure the safety of the vulnerable parent and to facilitate parent/child interaction during contact. In some cases, the parties will see independent management of contact as a desirable and/or viable mid or long-term goal. 3. Highly vigilant supervision: where contact is to occur where there are more serious risks or difficulties than those noted above, and where the service is equipped to deal with such cases, the service provides on site highly vigilant supervision. The primary concern is the safety and welfare of the child and of other relevant persons. In most cases, at this level, independent management of contact will not be a viable goal in the mid or longer term. These types of supervision are resource intensive, highly skilled and the risks and needs are such that supervision at this level is unlikely to be feasible for many services. Where such cases are undertaken, the service closely monitors and facilitates the parent/child contact during contact and the appropriateness of providing the service remains under constant review.
21 Although a single children's contact service may offer the three levels of supervision, vigilance, resources and expertise are significant determinants of the services offered. The way services operate and the aims of supervision depend largely on the type of cases the service accepts. 3.2.3 Principles Children's contact services, what ever form the service takes, should be as follows: 1. Independent: services should be independent from the parties, the dispute or difficulty and from other bodies or individuals involved in the dispute or difficulty. Contact services should independently determine whether they are prepared to take, and able to accommodate each case. 2. Accessible: services should aim to be as location-appropriate and as linguistically, culturally and financially accessible as possible. Services should aim to be accessible to adults and children with a disability. The diversity of client needs should be recognised and, as far as possible, accommodated. The preferred language of the parents and the child should as far as possible be respected and this should be taken into account in designing supervision arrangements. 3. Safe: where safety is an issue, services should aim to provide as much assistance as is reasonably possible to attempt to ensure the safety of the child and the safety of the vulnerable parent, at all relevant times. The safety of all, including supervisors should be treated as a prerequisite and not as something to be balanced, negotiated or compromised one against the other or against other considerations. The service should report child abuse and criminal offences to appropriate authorities. 4. Pleasant: services should aim to ensure that the contact experience is as pleasant, comfortable and satisfactory as possible for the child and the parties. Supervisors should model respectful and courteous behaviour. 5. Welfare of the child: subject to the precondition of the safety of all relevant people, the emotional and physical welfare of the child is the principle concern of contact services. The intervention of the service should benefit the child and not expose the child to harm or danger. The welfare of the child has, amongst other things, implications in relation to confidentiality and the limits to confidentiality. 6. Facilitate parent/child interaction during contact: services should aim to facilitate positive parent/child interaction during contact. This is not to say that contact services are actively or tacitly advocating contact- as pointed out above that is a decision for others. In cases where independent management of contact is a viable goal of the parties, facilitation of the parent/child interaction during contact is clearly appropriate. Where independent management may not be, or is not, a viable long-term goal, but the service accepts the case, the purpose of facilitation is to attempt to ensure that the child benefits as far as possible from the contact. 7. Facilitate resolution of parent/parent interaction issues: in cases where independent management of contact is a viable goal of the parties, services should aim, where possible and appropriate, to address the practical aspects of parent/parent interaction which adversely impact on contact, while remaining within the bounds of the services role and expertise. The process, however,
22 should not be forced and it will generally be inappropriate to place a time limit on the availability of the service. 8. Special problems such as alcohol or drug use, violence, inadequate parenting, mental illness, post-separation grieving, depression, and child abuse are not things that the parents can remedy together because the solution may lie with one, not both. Services must be realistic and be aware of the difference between issues where there may be a possible solution through joint effort and issues where the solution lies with one of the parties. Staff training will be of crucial importance.
Case Study 2: The United Kingdom
3.3.1 Context The UK is typified by a large number of contact centres, primarily administered by voluntary agencies on a contract basis. The Children and Family Court Advisory Support Service (CAFCASS) is the key body advising the courts on family and children matters. It has initiated several studies of which the most important is the work of Aris, Harrison and Humphreys (2002). Their analysis of contact centres is the key document outlining the condition and problems of contact centres in the UK. It is argued that child contact centres provide safe and comfortable venues and environment to encourage contact under difficult circumstances. They are most often used when no suitable alternative exists and are considered to be of benefit in establishing and maintaining contact whilst safeguarding the children concerned. Referrals are from social workers, solicitors and occasionally the family itself. 3.3.2 Usage The majority of these centres (CAFCASS refers to around 150 centres) are grant aided. However, an ONS (Office of National Statistics) survey indicates that they are used by les than 1% of children. Furthermore, a shortage exists for centres dealing with high-risk cases where vigilance is required and there is also a lack of clarity over their usage. Inappropriate usage has been identified where resident parents use centres maliciously to deliberately impoverish the relationship between a child and a nonresident parent. The National Association of Child Contact Centres (there are 350 members) has developed definitions of supported and supervised contact and has agreed with CAFCASS a protocol for mutual co-operation in safety, information exchange and liaison arrangements with centres. 3.3.2 Guidelines for use The definitions which guide referrals clarify whether contact is supervised or supported and whether any additional elements are required to meet identified needs. In this case we are interested in supervised contact because the child has been determined to be at significant risk of harm during contact. The emotional well being of the child is to be ensured whilst promoting the building and sustaining of positive child relationships with non-resident members of the family.
23 Table 3: Contact guidelines display CONTACT GUIDELINES - UK Contact demands individual supervision with the supervisor in constant sight and sound of the child, which in turn requires the support of an additional, nearby colleague. There must be a high commitment of resources including continuity of supervision and professional oversight of staff The supervisor and the Centre should have access to all relevant court papers Contact is to be closely observed and recorded in a manner appropriate to the purpose of protecting children and working in a planned way with parents Venues shall provide privacy and confidentiality to each child and family and structured to provide maximum safety and maximum stimulation for children Contact must be time-limited with a planned aim to assess and review not only progress but also the possibility of a safer future outcome.
USE OF CENTRES –UK When suggesting the use of child contact centres, ensure the court and the family understand the definitions of contact and what is proposed When making a referral, clarity and understanding over precise arrangements must be shared between practitioner, parents and the centre co-coordinator. Practitioners must ensure that information concerning potential risk to the child, parent, centre worker or public is provided to the centre at the point of referral via an agreed risk assessment and/or referral form. Where possible, arrange for the family to have an introductory visit to the centre.
In the cases and related standards of conduct described above, supervisors must be skilled and confident enough to intervene firmly where appropriate during contact visits.
Case study 3: United States
3.4.1 Context This case study is restricted to provision for social welfare families, as is the Access Centre in this evaluation. Child contact and associated centres have been the subject of continuing discussion and development in the United States over the last twenty years. A significant body of professional published debate has emerged during that
24 time and contact centre introduction has become a mainstream news item. Articles such as "Centres Provide Neutral Ground for Parents: State's Family Visitation Centres Are Safe Places for Visiting or Exchanging Custody." (Charleston Gazette 1C, December 26, 2000) are typical. Some state legislatures such as Louisiana are currently drafting legislation, which sets standards for referrals, operational requirements and funding. Centres, however, tend to be small non-profit organizations whose grant dependent status renders them vulnerable. 3.4.2 Standards The Child Welfare League of America has developed standards that guide thinking on visitation. These standards are based primarily on the rights of children and parents to continued connection (unless contraindicated for reasons of safety). Children have the rights of opportunity to maintain contact whilst parents have the rights and the responsibility to maintain regular contact. Foster carers, social workers and any agency involved in the care of the child should respect the parent child relationship including visitation. Visitation is to be encouraged only where the experience is a positive one for the child. Courts and Federal governments have added to or made more specific the practice around children visitation, especially in the case of violence. The key element of state guidelines draw on the body of work created by Hess and Proch (1993) and refers to the visitation plan and its close connection with outcomes. Table 4: Visitation plan standards display VISITATION PLAN STANDARDS – UNITED STATES The visitation plan should be a written part of the overall case plan The visitation plan should address the full logistics of visit frequency, time spent and who may visit. The visitation plan should be developed with the full co-operation of parent and child to the appropriate extent. The visitation plan should be distributed to all involved: parent, child, foster carer, relatives and providers The visitation plan should be regularly reviewed Support of visitation should be a requirement for foster carers Guidelines for child safety should be provided. Return home is not permitted until the family’s ability to safely manage unsupervised visits has been clearly established. The agency should articulate clear prohibitions around withholding visitation for reasons of punishment Expectations of parents, fosters, children and workers in terms of supporting visitation should be clearly set out.
25 3.43 Cases In order to examine concrete practice in the U.S., this case study focuses on several organizations. (1) The Supervised Visitation Network is an association of agencies providing services for separation and divorce but also for child protective cases. This organization has developed standards that inform practice. (2) The Californian Professional Society on the Abuse of Children provides information and guidelines where sexual abuse is involved. (3) In addition to provision of supervision, the Catholic Charities Therapeutic Supervised Visitation Program in Buffalo, New York, provides treatment to those families involved with child welfare. This latter project is of particular interest to this evaluation since it has expanded its service appropriately. (1) The Supervised Visitation Network formed in 1992 responding to the rapid pace of development of centres without appropriate written standards for practice. The organization developed standards for types of service offered, security, staffing, intake, termination and recording. The organization addresses special precautions for safety and suggests training and recommends therapeutic support for those in sexual abuse situations. (2) The Californian Professional Society on the Abuse of Children pioneered the introduction of guidelines to assist decision-makers as to when monitored contact visits were appropriate. It now seeks to provide a model for desirable professional practice. The organization addresses conduct applying to monitored rooms, visiting parties, the specify language that parents should use during visits and transportation protocols. It offers suggestions for involving the child in planning, how to talk to the child and how to involve the child in determining the content of visits. (3) Catholic Charities of Buffalo, New York operates a wide variety of services. Its Therapeutic Supervised Visitation Program deals with families involved with child welfare services and draws on the child and family’s strengths. Supervised visitation aims to ensure ongoing contact between parent and child when safety is an issue to prevent (further) maltreatment of children. The program works towards unification by focusing on attachment issues and it provides a healing environment to assist the unification transition. Therapy is integrated into the service and all involved are encouraged to participate. Ultimately however, responsibility for cases lies with the Department of Social Services (DSS) case manager. The centre is located centrally with bus transport available. Visitation rooms are specially designed, secure spaces with age-appropriate furniture and a variety of play resources. Rooms are large enough to allow distance between the supervisor and parent-child and have video camera and microphone equipment. The centre employs security personnel. Visits are allowed on weekdays from 9 a.m. until 8.30 pm and at weekends from 9 a.m. until 4.40 p.m. The foster carers provide child transport, whilst parents provide their own transport. All visitation centres in the United States appear to suffer from instability of funding. Whilst they benefit from set-up costs granted by federal governments securing operational costs is more difficult (receipt of capital costs are always easier to achieve whilst running costs - especially for wages - tend to be problematic). Centres have long waiting lists and referral criteria tend not to be rigourously observed by social services practitioners. If they like the work of a centre, social workers refer too many clients and this results in higher costs for centres. Additionally, US evidence suggests
26 that stand-alone centres should be integrated with other community services (Thoennes and Pearson 1999).
3.5 Conclusions and lessons for this project United Kingdom case study information suggests that the project under review is well placed within the Health Board structure. Here, the state has taken the lead rather than subsume pre-existing voluntary and NGO activity. The project is in a good position to develop guidelines that suit the specificity of Ireland. The Access Centre may wish to suggest the adoption of the UK system for research-based consultation in determining the views of children, parents, fosterers and other involved parties. The project can usefully draw on the New Zealand and Australia material for vigilance levels. The determination of vigilance level or case intensity can assist in drawing up care plans, planning the work of the centre, adjusting staffing levels and using time resources. The case studies suggest that it should also be used in all aspects of the referral process. The United States experience suggests that long-term funding is crucial. Key characteristics emerging from the US are a commitment to staff training and an emphasis on the therapeutic aspects of access visits. Child contact not only offers the chance of maintaining family contact but also presents an opportunity for role modeling, parenting lessons and therapeutic interventions that aim to resolve attachment difficulties. The adoption of visitation plans are be a useful tool in the resources available to the Access Centre under study. These may be usefully expanded in line with the above case. The United States experience usefully points to the importance of awareness of anticipation and aftermath for the child. The chart below (Chart 2) displays the process and actors involved in the current process in the project under review. All the states under review pay attention to the community level and urge the integration of access, contact or visitation centres into pre-existing services. Whilst this more properly applies to contracted services outside the statutory sector, it should be noted that where an access centre’s “locationality” offers a discrete catchment, it is useful to generate links to community services (which may also be serving the Access Centre customer or client). For example, where transport is problematic for parents, this might be offered by a community-based service to a client with a chaotic lifestyle.
Chart 2: The visitation flow in current practice
Child is expectant 1. Child may be ambivelant "I don't want to go." 2. Foster carer may be concerned
Child is in new situation 1. Parent may be nervous "Will my child remember me" 2. Child may display attachment difficulties
Child has to endure parting 1.Child may be upset/tearful 2. Parent may be upset or tearful 3.Foster Carer has to cope with emotional aftermath in family
ACTORS 1. Child 2. Foster carer 3. Access./Transport Officer
ACTORS 1. Child 2.Parent/s 3. Access Worker(s)
ACTORS 1.Child 2. Parents/s 3.Access Worker 4. Access/Transport Officer 5.Foster Parent
Phases of development
4.1 Introduction: The following chapter outlines the phases of development in the life of the Access Centre. This follows development from the initial idea to the operationalisation and administration of the project. The approach used in this chapter is to examine the stages of development as signposts for those wishing to introduce a similar project. It therefore stresses not only good practice but also outlines the pitfalls and unpredicted obstacles which may occur during the process As has been noted in a previous chapter, the development of the Centre is unusual since it was generated from within the state structure. In many other states, development has generally relied on voluntary organisations to provide centres to which statutory services then refer. It must be recognised that this dynamic is atypical. As can be seen from the previous chapter, voluntary or NGO bodies have generally taken the lead and have for the most part provided responsible for setting up codes of practice and operational guidelines. In this case, development and operational developments are entirely internal to the Departmental social work function. Referrals are made by social work officers working within the statutory service. The Centre therefore lies outside any partnership structure and relies entirely on internally generated resources. Whilst partnership working may offer an area for further development, it is important to acknowledge that the growth and development of the centre lies within the necessary constraints of a government department with statutory responsibilities. This chapter sets out to chart the Centre’s development in a linear fashion. In this way, more centres can be developed in other locations using the current one as a model. The study therefore attempts to locate important developmental points. It additionally locates the exact points where delays are likely to occur. In this manner, such delays can be anticipated and minimised in the future. Naturally every location will have difficulties, some of which are a product of local circumstances. As far as possible therefore, the chapter attempts to examine problems that may be generic to the operationalisation of equivalent organisations in similar circumstances. It is also important to acknowledge the starting point. The default position for access in the area concerned was one where social workers provided or arranged contact opportunities. It was acknowledged that this placed undue stress on social workers and demanded considerable resources. In addition to supervision time, social workers expressed considerable frustration due to the amount of time spent in arranging transport. The position was recognised in 1996 and remained a priority in annual development plans. The proposal can therefore be identified in 1996. Workload research indicated that in Community Area 7, some 59 children cases involved access visits, which averaged 5.4 per worker. A total of 79 children were involved in these visits of whom 37 required supervision and 49 needed transport. Of the total number of case, 47 (80%) were considered suitable for Access Centre services. In the period 1996-2000, the level of Court Ordered Access (COA) saw a significant increase. This reflected a growing attention to children’s needs and child centred work
29 in that period. Although some of the orders were felt to be in excess of an appropriate response to the child’s best interests, resource issues dominated. The projected demand for 2000 was estimated at 110 cases for Access Unit provision. A proposal for an Access Unit was drafted in June 2000. Central to the idea was the contention that the service would separate social workers from the necessary adversarial role, fulfilled by them in court cases. Through distance from the social worker, in both location and role, an Access Service would offer natural parents a better forum in which to promote healthy contact with their children.
4.2 Phase 1: The Initial Idea and Proposal The initial idea identified the purpose of an Access Unit. The unit would provide “an environment for children in care to have healthy contact with their parents in a safe and child centred environment”. The original proposal stressed the role of social workers. Cases would be referred to the Unit by social workers. Frequency, duration and supervision level would be determined by the referring social worker. Issues of child safety would be identified and clarified at time of referral. Initial consultation with social workers during this review indicated the perceived need for an access centre. Social workers indicated that access supervision could take up to 40% of total hours worked (two out of 5 days). In addition to acknowledging the need for more appropriate venues for visitation, social workers identified travel time as the biggest drain on their resources. This represented time, which could be allocated to preventative work. Social workers felt that all Community care areas should initiate access centres as a priority. The following steps in a visit were identified as represented in the following panel.
Table 5: 1. 2. 3. 4. 5. 6. 7. 8. 9.
Visit stages display
Making of arrangements Preparation of child Transport to visit Supervision and support Return of the child Support to child after the visit (aftermath) Feedback to carers Recording of visit Feedback of social worker.
The proposed physical design originated in 1996. The design specified a bungalow style purpose-built unit with the possibility for expansion. Key elements included two access rooms adjoined by observation rooms for unobtrusive monitoring of family interaction. The rooms offered access to garden areas for play and included kitchen facilities to allow families the opportunity of cooking and eating together. The proposal included nursery and changing areas, waiting areas and administrative and meeting space. The proposal further specified wheelchair access for the building and toilets. The proposal specified a dedicated minibus, which would replace the use of taxis.
The proposal specified a manager with childcare or social work training and supervisory experience together with appropriate administrative and clerical assistance. Anticipating two access visits taking place simultaneously the proposal further specified three trained child access workers. Given the importance of transport the proposal further specified a full time specialist Transport Officer who was fully able to deal with responses, reactions especially in relation to aftermath. The report specified appropriate resources in terms of appropriate fixtures and fittings including television and video, nursery equipment, toys and kitchen equipment. In addition the proposal recognised the necessity of security equipment. It was additionally recognised that full compliance with health and safety, having special consideration for children, was necessary. Overall, the proposal demonstrated an awareness of the potential of Access Centres and their role and function. Anticipating the focus on children safety, it sought to provide for families a safe and bounded environment in which parents could not only maintain contact with their children but also, for a short period, join mutually in aspects of family life. Whilst the proposal sought to separate families and children from the element of coercion introduced by the courts and to provide more effective use of social work resources, it also provided for a learning experience for both parents and children. In this way, it anticipated future legislative and administrative arrangements pertaining to children and families.
Phase 2: Development period following the appointment of the Coordinator The appointment of an Access Centre co-ordinator in 2000, allowed for the further development of the proposal, prior to implementation. The remit of the co-ordinator was to consolidate and update information, disseminate recent findings, provide an operational structure and accompanying guidance, to administer the development period and to generate the specificities of a job description and person specification for the post of Access Centre Manager and Access Workers, policies, procedures, guidelines for all projected staff, code of practices and all written work. The coordinator also performed cover for existing access casework during this period allowing for increasing familiarity with the territory and the testing of opinion on projected innovation. The co-ordinator immediately conducted research by surveying social work teams in two areas covering Ballymun and the North Inner city. Research findings confirmed and superseded the position projected in earlier documents. The original table is reproduced below.
Original position of access work in Community Area 7 display
Actual nos. Estimated nos.
Position at September 2000
Cases involving access visits Total no of children involved Cases involving supervised access Cases requiring transport Cases suitable for an Access Centre Cases requiring security officer on premises
109 193 67 78 78 9
140 250 90 100 100 12
The figures in the second column have been factored up by 1.32, to represent the total number of social workers with access responsibilities, who could not be surveyed. This gave an overall indication of current demand and confirmed previous projections. It elicited additional information on transport and security requirements. In addition, the coordinator’s report emphasised the findings of current literature and noted the uneven nature of development in most EU states. In particular this allowed the project to assess additional benefits of Access Centre provision. The most important findings indicated that long-term children benefits include improved coping skills and a reduced likelihood of emotional disturbances in later life. The coordinator refined the original proposal to include remedial intervention effects as indicated in the display below.
Anticipated remedial intervention display
To ensure children receive important information about their own origins To clarify for a child why parents he or she no longer lives with are unable to care for him/her To ensure that a child’s self image is not damaged by losing touch with someone who has been important for him/her To assure a child who is anxious about the well being of his/her family To ensure that children do not develop unrealistic and potentially harmful fantasies about their absent parents Roulston and McClogan (1997) This was an important addition in the child-centred development of an ethos for the Access Centre and formed an important foundation for development.
4.4 Phase 3: Appointment of Manager The Manager post is an important milestone in the development of an Access Centre. Most statutory bodies work to specific protocols regarding posts. They must have due regard for equal opportunities so it is customary for the person carrying out development to be asked to apply for the post which she or he has created. This can
32 create a certain amount of unavoidable stress for the existing post holder, and at worst it can irritate applicants who are unlikely to succeed. It is, however, an extra resource demand that the sponsoring body must factor into its financial projections. This can be avoided by appointing a Manager in advance of development. Yet if the introduction of an Access Centre is a pilot project, this must be accommodated through an appropriate time bounded contract. The advantage of early appointment is to avoid the significant expense of the recruitment process. The disadvantage is the allocation of a permanent post for a project, which may not come to fruition. Some space occurred between appointment and the entry to existing premises. The manager utilised this period for placing of advertisements and commencement of staff appointments. The staff appointment procedures took place through liaison between Centre Manager, her line manager and a representative from Shared Services. Court action slowed entry to the premises until February 2002. The selected premises was already occupied by a tenant – a client in the care of the Department for whom it had statutory obligations. Entry could not take place until this person had vacated. Delay occurred principally because the Department experienced difficulty in obtaining suitable premises for decantation. It must be noted that the Courts share some responsibility for delay since it insisted certain conditions being met. Further delay took place due to necessary reinstatement of the premises, which had suffered from neglect and damage, principally due to the action of the existing tenant. It is felt that the difficulties in which the client found herself exacerbated the problem. Further damage occurred during the period of court decision-making. By default, this became the technical and financial responsibility of the Access Centre.
Phase 4: Occupying the premises.
4.5.1 Introduction The various attributes of the premises will be covered in the following chapter. Safety is a major concern in setting up an access centre. The interim premises were generally found to be generally adequate for the introduction of the service. 4.5.2 The Building and Physical Resources Much of this section is devoted to child safety and the prevention of accidents. In this phase of development the occupation of an empty building allowed time for all problems related to safety to be addressed. This cannot be stated too strongly. It should be noted that there is a strong direct relationship between child accidental injury and social class. A report on injuries in Ireland states the following:
“The relationship between social class or social deprivation and Accident & Emergency attendance, injury admissions and injury mortality is well documented. (Walsh et al. 1996, Walsh and McCarthy 1988, McFarlane and Fay 1978). The relationship between fatal injury and social class has been found to be particularly strong. These relationships are particularly true of childhood injury. [Scallan, Staines and Fitzpatrick (2001)]
33 It is important to point out that most domestic premises are not purpose-built and will require remedial work in order to satisfy: 1. Operational suitability 2. Conditions ensuring heath and safety at work 3. Conditions rendering the premises safe for children and parents. In the case of the introduction of the Access centre, this required: 1. 2. 3. 4. Alterations to doors Removal of mirrored wardrobes Removal of sharp objects and furniture at children height Installation of gates on stairs for protection of small children
Whilst the existence of kitchen facilities can prove beneficial to improved interaction between children and parents, this places extra responsibility on project staff in terms of planning and operational surveillance. Yet it also provides a useful area for children education in accident prevention. A diagram can be found at http://www.juniorcitizen.org.uk/kids/homesafety/kitchen.php. This matter will be developed later in this report. Physical resource allocation demanded installation of telephone, alarm system, computer, Internet and intranet, improvements of internal and external play areas and the addition of play resources for children. Departmental authorisation prior to installation of all resources caused delay. A particular problem was that of play resources for which only a small budget allocation was made. Appropriate build quality in terms of both construction and material can be an expensive item that is easily overlooked. Sponsoring organisations should budget ahead appropriately and should ensure that budget heads accommodate items such as toys and educational resources. Those introducing a new access centre could usefully seek community partnership in the provision of play equipment. Child safety aspects also presented difficulties for observation and conventional rooms and circulation space initially presented some hazards for children. Childproof gates had to be introduced for stairs and doors. It is important to note that it is not possible for visits to commence before at least two members of staff are in place. This is a fundamental aspect of child safety. The parent and child cannot be adequately supervised where only one person is on the premises. Events as simple as a phone call or caller at the door can disrupt the supervision process. Thus visits may not commence until another member of staff takes up the appointment and is physically present on the premises. Those initiating a similar project must remember to programme the start of work accordingly. 4.5.3 Staff The Access Worker appointment took more time than expected due to delay in the recruitment process. The problem lies in the length of time in the staff appointment and selection process. Those initiating an Access Centre should acknowledge the time required. It is likely that somewhere between the advertisement publication through interviews to a letter of appointment being issued, the selected person may take up an
34 appointment elsewhere. This is exacerbated where there is shortage of suitably qualified applicants as was the case for the project under review. Despite these problems, an Access Worker was eventually appointed and took up her post in July 2002. A further post was transferred from the Santry social work office. This fulfilled the pre-existing remit but was conditional upon added contact facilitation and transport provision outside the centre. A further access worker post was relocated from the Santry office in 2005, again under the same conditions as described above. Although this assisted in maintaining safety protocols and allowed the Access Centre Manager the necessary space for administrative and supervisory duties, the original remit was subject to alteration. Staff transport commitments have considerable impact on the usage of the building. (This may also impact considerably on building developments as described in Development Phase 6.) The current position and status of workers remains unclear however. The following chart represents the current situation as of January 2006.
Current Organisation of the Access Centre
ACCESS CENTRE MANAGER
ACCESS CENTRE WORKER
ACCESS CENTRE WORKER
The evaluation notes the problems connected with the appointment of staff and uncertainty concerning the exact function of the staff at the Access Centre – especially with regard to transport duties. The final chapter will examine the staffing position and suggest ways in which the Centre can be reorganised and developed for maximum advantage. 4.5.4 Systems During this period, the manager developed casework monitoring forms and set up spreadsheets to record throughput data. This proved a valuable contribution to the life of the Centre. In consequence the Centre is in possession of accurate records regarding the status of all cases and can demonstrate its use of operational time.
Phase 5: Operational Commencement
35 4.6.1 The premises in use The following data refers to the period from January 2003 to the time of writing – November 2005 and covers approximately three years of operational practice. During this period, the Centre was administered by the Manager and one Access Worker. When leave of absence was granted to the access Worker, another worker was a seconded. It must be re-emphasised that no access visits may take place when there is only one member of staff present. The manager, and two access workers currently staff the centre. Both access workers provide services for visitations taking place offpremises under the remit of the Social Worker, based at offices in Ballymun. The first phase of operations took place at the start of 2003. 4.6.2 Transport Transport for children was arranged by taxis pending the introduction of a dedicated vehicle. There were both advantages and disadvantages to this approach. Advantages were as follows. Taxi use left the access worker free to engage with the chid en route to the centre and on return. In a dedicated vehicle the access worker has to give her main attention to driving. Depending on age, the child is likely to be alone in the rear of the vehicle. Taxi use provided a non-institutional framework for the child since the various drivers engaged well with the task and were able to provide a friendly service. It was noted that informal banter helped put the child at ease. The disadvantages however, outweighed the advantages for the flowing reasons. Taxis required advance booking. Taxis were unable to provide the same driver. At first, the same drivers were employed and this gave the child a sense of stability. However, in order to spread the work fairly amongst drivers, the taxi company was forced to vary the drivers. Taxis do not have child safety seating. In consequence, portable child seating had to be temporarily installed to the rear seat of the taxi prior to each visit, then uninstalled when the visit was over. The following chart examines criteria for cars, taxis and other forms of transport.
Transport criteria display This Centre
Dedicated but not secure Yes Yes Nearest station is 3km No: Low - medium
Using Transport Is there a dedicated secure car parking space for a centre vehicle?
Can a taxi or other vehicle draw in without danger to children and parents? Is there a bus stop close to the premises? Is there a train service close to premises? Is it a frequent service?
The introduction of a dedicated vehicle for transport offered great improvements for the Centre in terms of flexibility and control. However, workload demanded that the
36 taxi service be retained for some of the work. The importance of transport was stressed by a foster carer who said the following:
My children give a lot to the cared children and they have to share attention, their toys and their rooms. But they don’t like to be with me when I am picking up my foster child after a visit – there’s a lot of clinging and screaming and they find it very distressing. So a pick up and delivery service makes a big difference to all of us. [Foster Carer]
The process of locating and retaining a vehicle however, proved less than adequate. A vehicle no longer utilised by another department was identified and the vehicle transferred for use of the Access Centre. Whilst this was useful and demonstrates good interventionist skills on behalf of the Access Manager, the importance of Access Centre transport appears undervalued by the Department as a whole. This suggests that transport is seen as an operational function only. However it is vital that the emotions of the child be taken into account during the transport period. The anticipation, expectations, likely disappointment and distress of the child during this process must be taken into account. It is fundamental that the psychological well being of the child is recognised. This demands care in the process of moving the child from its foster home to supervised access and back again. As may be seen from the table below, the number of transport hours is almost equivalent to the number of achieved supervised hours. Although this relationship changed slightly in the most recent year under review, as the Centre staff brought travel time down to below that of supervised time, this may be due to the presence of a dedicated vehicle in addition to taxi use. Those setting up an access centre must closely examine their catchment area and monitor transport time carefully. Table 8:
Year 2003 2004 2005 Total
Travel and supervision time display
Supervised hours 530 436 431.5 1397.5 Travel hours 643.5 510 379 1532.5 Total time per visit 1173.5 946 810.5 2912.0 Supervision as % of total time 45% 46% 53% 48%
However, the general tendency to regard the transport function as neutral lowers its value in the eyes of workers outside the Access Centre. In consequence there is a pressure from social workers to use Access Centre staff as transport personnel for case of lower vigilance levels. The matter of transport must be considered as important and deserves a review, which examines planning, and the possible introduction of dedicated transport personnel. This review should identify all transport duties of social work and ancillary personnel with a view to the introduction of a managed departmental transport function. The review should be child centred and regard the well being of the child as paramount. 4.6.3 Bookings The Access Centre’s first phase of operation represents a full immersion in necessary visits rather than one of building up bookings and referrals. There were more bookings in the first year than in either of the next two years. 2003 can be regarded therefore as the “pilot year” when the booking capacity may be tested. It is also the most likely period for difficulties to arise and these should be monitored carefully.
Year of Operation 2003 2004 2005 Total
Bookings and completed hours display
No of Visits completed No of Supervision hours Average supervision hours per visit
182 245 260 687
530 436 431.5 1397.5
2.9 1.7 1.7 2.0
The average number of supervision hours per visit was relatively high in the first year of operation. This dropped and stabilised over the following two years. The Access Centre sought to establish a balance between the number of visits it could accommodate and the period of contact time that can be facilitated between parent and child. Those initiating an access centre should, through careful planning, seek to establish a balance between the following actors: 1. Child – taking the age, health, development and maturity of the child into account, what length of visit can be accommodated and is best for the child? 2. Parent – given the capacities of the parents and the relationship with the child, what contact time is suitable? 3. Fosterer/carer – what are the demands on the carer which must be accommodate with reference to his/her own children, household schedule etc? 4. Centre – what contact time can be accommodated given the number of staff, safety requirements, physical resources and case intensity? The evaluation notes the drop in average contact time after the first year and recognises the limitations of child contact. Contact time is constrained by the ability of the parent to maintain concentration in an environment which he or she may find alien. This area requires further monitoring to judge the most effective contact time period for certain parents. Their ability to respond to the centre environment should be taken in to account. The evaluation recommends the use of dedicated software to assist with visit planning. This would take account of resources and analyse bookings, seasonal fluctuations, cancellations and outcomes. A package such as Cubistx may be suitable and can be found at http://www.cubistix.com/child_welfare_services.cfm. This type of programme takes into account transport options and offers caseworkers a useful planning tool. 4.6.4 Cancellations Cancellations ran at a high level for the first few months - almost equal in number to completed visits. These should be considered closely to determine sources of and reasons for cancellations. (Included in cancellations are parental “no shows” or nonattendance). Access centre statistics are available for the three full years of operations. These reveal that cancellations have gradually been reduced as a percentage of bookings. This reflects a service development in relation to client tolerance levels.
38 Protocols were put in place that located significant non-compliance of the visiting parents. Having due regard to the well being of the child and to the objectives of the centre, a boundary is established. More than three missed bookings will trigger a review of supervision arrangements. Table 10:
Cancellations Bookings Cancellations as % of bookings
Cancellations by year display
2003 2004 2005
111 293 38
87 332 26
73 333 22
Over the total period the average cancellation figure is 29% of bookings. The Access centre has worked hard to reduce the overall levels of cancellations and has reduced these gradually over the period of operation. A further analysis shows that cancellations may arise from the following five areas. Responsibility for cancellations lie across the key actors within the operational system Table 11: Non-attendance analysis display
2003 2004 2005 All
Responsibility Non-attendance parent Parent Child Carer Social Worker Access Centre All
18 29 7 19 38 111
20 27 17 10 13 87
28 17 12 14 2 73
66 73 36 43 53 271
The tables above show that the main responsibility for cancellations lay with the parent group. Although this reduced in the third year of operation, it nonetheless remains the key problem group when combined with “no-shows”. The Access Centre itself shows a high level of cancellations but this needs to be examined across the time period. The cancellation rate in the first year of operation clearly reflects the difficulties encountered at that time. Access Centre cancellations dropped dramatically in 2004 and were nearly eliminated in 2005. This shows that the Centre recognised the difficulties and worked hard to improve scheduling. Nevertheless, a foster carer who made the following contribution identified a lack of adequate staff cover:
I hate the cancellations because it’s very frustrating for the child and me. I have my plans disrupted and on top of that I have to cope with the child who is disappointed and tearful. I understand the difficulties but it seems to me that the staff at the Access centre need more cover. [Foster carer]
Interestingly, parents consulted also noted this aspect. Staff maintained regular contact with parents and worked with other parties to reduce cancellations. This produced an across-the-board drop in all categories. The evaluation found that reasons
Does not include November and December figures
39 for cancellations primarily arose from the same kind of family problems that caused the care order. So those initiating an access centre need to bear in mind the likelihood that certain difficulties will affect the clients’ ability to maintain a visiting schedule. Once specific reasons are determined the centre may work towards minimising them. 1. Of these drug and alcohol abuse will play a part in the cancellations. The later can be minimised by paying attention to the parents’ duties and responsibilities. For example, Monday mornings are difficult for anyone in methadone-assisted recovery and this should be avoided by not arranging visits on a Monday morning or at a time when a visit to the methadone clinic for urine samples are scheduled. 2. Difficulties around separation and divorce constitute another reason for cancellation. The parent/s may be in the process of establishing a new relationship or be in the aftermath of an old one. The parent taking prime responsibility for visits (there is usually one that takes the lead) may attempt to bring the new partner – a situation that should be avoided. The new partner (1) may not be known to the child concerned or (2) may attempt to sabotage the visits through control of the visiting parent. 3. Difficulties around court appearances and other welfare responsibilities may interfere with schedules. The parent must respond to court-initiated demands and give them priority. There is little choice and the centre must adapt. Similarly for social workers, there are other duties which may coincide with a scheduled visit and must take precedence 4. The time of year has an effect on clients’ predisposition to make a visit. Summer periods are vulnerable to cancellation, especially if related to aspects of (2) above. Conversely, parents may wish to see their children at the Christmas period when a centre is working with reduced staffing. 5. Difficulties can be presented where parent/parents are working or obtain employment during the period where their child is in care. Although most parents in this study were not working or were doing casual work (possibly in the informal economy), employment is generally seen as a beneficial and stabilising influence on clients. However, this presents an obstacle to visits. Extension of visiting hours would therefore increase accessibility for parents. 6. Family responsibilities present problems for larger families or where one child is in care and a sibling or siblings remain with the parent. School problems, ill health and family dysfunction can all contribute to the likelihood of cancellations. Where family dysfunction can be expected, large families present many problems associated with disruptive behaviour and a chaotic attitude to appointments. 7. Client vulnerability is possibly the main reason for cancellation. The parent may not be in a position to respond because of personal problems around selfesteem, anxiety and depression. If the parent is worried about the visit, he or she may prioritise other duties and responsibilities as a defence against anxiety about the visit and his/her relationship with the child. During this evaluation,
40 Access Centre staff made considerable efforts to determine the problems and talk them through with parents. Those initiating a service should be aware that “emotional monitoring” might help to reduce cancellations. All of the above problems have been experienced during the introduction of the Access Centre. Given the characteristics of this client group, the likelihood of completely eliminating cancellations is unlikely. But cancellations can be minimised by the appointment of an adequate staff complement with capacity for cover and a dedicated administrative specialist with knowledge of the client group. The latter would work to maintain contact with the parent/s and to raise the capacity for visiting. The bulk of scheduling and rescheduling work currently undertaken by the Manager should be devolved to this appointment. Extension of the centre’s available hours to evenings and weekend would assist working parents and extend choice. Finally, the staffing complement of Access Centres should be such that emergencies, periods of pressure, and training duties can be managed correctly. Visits must be scheduled within the capacity of the Centre rather than at its capacity. Those initiating an access centre should bear in mind that clients may cancel because of one or more of the above factors and adopt systems that identify and reduce non compliance. Cancellations are emotionally distressing for children and may trigger (further) feelings of abandonment. This involves developmental work with parents. Although some developmental activities take place in the normal course of visitation, it may be necessary to refer the parents for counselling and related activities to increase their likelihood of maintaining their part of the visiting plan. The service may like to consider the appointment of an on -site counselling service similar to those in the US case study identified in Chapter 3. This service would seek to help the parent/s in areas of priority building, maintenance of boundaries, relationships, and child development, parenting skills. Discussions with clients in relation to their own experience of parenting may be helpful in this regard.
Phase 6: Planning and occupation of the Purpose Built Centre
4.7.1 The new site The objective of a dedicated site and a purpose built premises built on a dedicated site was in existence from inception of the project idea and the original plans are part of the first proposal. The planning of the purpose built centre takes however, place contemporaneously with the commencement of the operational phase whilst working from the temporary centre. The evaluation recognises that this takes place within the overall planning environment of the Health Board. As such it must take in to account the following: 1. 2. 3. 4. The financial resources available The current land values and land availability at a suitable location The existence of existing Health Board sites suitable for development The potential leverage capacity in attracting developers and obtaining value for money (VFM).
41 Current economic dynamics within the Dublin region have promoted an escalation in land values. Whilst this may have a negative effect on purchasing a dedicated site, it increases the options for the use of a pre-existing site with scope for development. The Board chose to develop an available site, bordering parkland in the Ballymun development Area. This site was already occupied by another child care service. It is important to recognise that this site lies close to Ballymun centre and as such comes under the planning process of Dublin City Council Development Plan and the Ballymun Rapid Action Plan (http://www.dublin.ie/ballymun_rapid/). The City Development Plan contains options for urban development, transport links etc
Under the Regeneration Programme, over €1.8bn has been made available for regeneration of the physical infrastructure of Ballymun. Alongside this RAPID offers an opportunity to develop a new, area-based and integrated approach to tackling social exclusion and cumulative disadvantage in the area. [RAPID web site]
Regeneration details are available from http://www.brl.ie/wnew.htm Those initiating an Access Centre should remember to check all development plans since in the life of a new centre, since development initiatives will change the nature of the environment for all actors. In this case, improved transport links will serve parents, fosterers and Access Centre staff. Improvements to the spatial environment will bring local parks and within the physical environment provide new resources in the community infrastructure. The latter should prove a useful improvement for the Access Centre and further developments in community welfare services will provide options for working in partnership. 4.7.2 The physical environment The development of an existing site brought both advantages and disadvantages. In retrospect, the opportunity for a dedicated site was a possibility given the existence of various bodies charged with area re-development. This may have offered partnership potential. As such, it is to be regretted that this option was not given more attention at Departmental level. (1) The site selected for development was one of the Health Board's existing sites, set in woodland. Some of this woodland had to be removed to build the Access Centre. Although it is accepted that some site development is necessary, woodland would have improved the environment and offered resources for parents and children in visitation. (2) Leverage in this case, demanded ceding a portion of land to the developers. The advantages of this action for the Access Centre remain unclear. (3) The selected development site was in occupation. Since the work entailed redevelopment of existing accommodation, staff had to be temporarily decanted into the new Access Centre; in addition to enduring a deleterious change to their woodland environment. This slowed entry to the new premises and caused additional refurbishment work to be necessary prior to the Access Centre staff taking occupation. At the same, disruption to the existing occupants of the site gave rise to some resentment. Site development conditions, decantation and re-occupation of their
42 premises naturally proved disruptive. Liaison with existing staff was necessary in order to preserve future working relationships 4.7.3 Interior of the new building The building’s interior and curtilage offers clear improvements on the existing premises. The design, for the most part, follows the original proposal and includes observation rooms, and additional office and administration space. The entrance leads to a reception area with administrative space lying to the rear. The building presents onto an adequate car park and is south facing. The three access rooms (with attached observation rooms) have kitchen facilities and a rear garden, which cannot be overlooked either by neighbours or by other families in adjacent rooms. One-way mirrors and video cameras6 offer adequate observation facilities. The premises offer more sophisticated security arrangements than the existing premises. Video cameras linked to a central display have obvious benefits, although this feature requires adequate personnel to monitor and control the premises. Those introducing such features to an access centre should also have due regard to safety features around the exterior of the premises. The building offers a light and airy corridor featuring natural lighting from skylights. This corridor links the reception to the observation rooms. However, the observation rooms are north-facing and suffer from a lack of natural light. Situating the observation rooms on the front of the building would have improved lighting but obviated access to the private gardens. This is something to be considered early in the planning process, whilst recognising that every site will exhibit certain physical problems. There is adequate storage space for toys and games. Storage space allocated to toys and games should allow for the child to be able to find his favourite toys in the same place as they were, when tidied at the end of his or her visit. Some difficulties were encountered during the building phase following first and second fix carpentry, electrics and lighting. These were mainly related to specialist aspects of the access centre function as follows: Work surfaces were inappropriate for use by children. Generally the ergonomics of access rooms were adult-orientated. Siting of boilers and geysers presented safety hazards and were unsuitable for the purpose of the centre The position and type of lighting were unsuitable for visitation. Lighting is a specialist area and is related to both visibility and mood. It requires careful forethought. Private space for the manger was not taken into account in the completed building, leaving only an open space behind the reception area. All service buildings require a quiet space, which can always double as meeting accommodation. In general, all files should be held securely in a closed-off space that may not be accessed by clients. Most of the problems encountered during this period indicate a failure on the part of the architects to adequately manage the specialist demands of a building of this kind
At the time of writing, cabling had been fitted but hardware was not in place.
43 and is fundamentally related to the understanding of the purpose of the service. There is a need for the building to convey a feeling of safety, containment, warmth and privacy. This should be adequately understood by all involved with the planning of a new building – especially architects and building supervisors. The need for an empathetic awareness with the building’s future users – children, parents and staff - is paramount. The demands on the access rooms are as follows: The rooms must offer a generous circulation space in which the parent and child may move around as if in a domestic setting. There should be adequate space for play and games. Rooms must be brightly but not harshly lit. There must be an unobstructed view between two-way mirrors and the circulation space. The primary consideration of safety must be observed such that children are not exposed to hot surfaces, scalding water, projecting work surfaces and electrical outlets. The problems in this period appear to relate to the needs of the decantation period. In consequence, the building seemed primarily designed to accommodate adult staff rather than the end user. Those introducing an access centre should try to ensure that temporary accommodations do not influence the final shape of the accommodation, since alterations after the completion of building work can be more expensive. It is useful to employ a childcare professional to “snag” problems contemporaneously with this phase, such that post hoc alterations are minimised or eliminated. 4.7.4 Entry to the purpose built premises It must be noted that at the time of writing, Access Centre staff have not yet relocated to their new building. The building is currently empty and awaiting refurbishment following the return of decanted staff to their original premises. No firm date is available for Access Centre entry to the new premises, although it appears likely that this will take place in early 2006. As such, this phase remains incomplete. All stages of this development took longer than anticipated. Those seeking to develop access centres should strive to reduce delay since it has a knock on effect on staff (demoralisation) and clients (disruption). Clients who’s lives are marked by chaos require stability and some level of certainty. At the same time, open government demands that they be fully informed of developments. It is useful to note that delay is not fully understood by younger family members - especially teenagers.
4.8 Conclusion and observations The chapter tracks the development of the Access Centre from proposal through implementation until the period prior to entry to the purpose-built premises. It sets out both the outcomes (in terms of throughput) and the difficulties encountered during implementation. In terms of evaluation, the focus remains on the purpose of the Access Centre, which is fundamentally offers the opportunities for children and parents to maintain contact where the child is out-of-home for legal reasons associated with child protection. The development phases were constrained by scarce resources in the following areas: staff resources (access workers, drivers) and physical resources (premises, equipment and dedicated transport). In every phase, systematic delays and obstacles hindered
44 development. These lay outside the control of the staff members that were implementing the developments. In consequence, project implementation took much longer than envisaged. An overall examination of Health Board systems associated with recruitment, building control and general resourcing would assist in reducing these delays - all of which have a cost implication. In particular, two major issues remain – those of (1) Staffing and (2) Transport. Both these areas require a major review. In order for the centre to function safely, additional staff members are required. The work of the Centre is clearly strained if there is staff absence because of limited cover. In this development period, the manager has provided cover where necessary. But this reduces her capacity to perform the main duties of the post. Additionally, overseeing the development of the new building has involved significant time. Much of this could have been avoided had project control proved tighter than was the case. Many successes were registered in this period. Staff members were able to initiate and develop systems exclusive to the centre and to develop codes of practice appropriate to the sensitivity of the tasks involved. Consultation with foster carers and clients (parents) demonstrated a satisfaction especially in comparison with pre-existing systems. Observation of children showed that they were safe and well cared-for. Staff worked well to provide supervision. They maintained boundaries and coped well with resource limitations. Throughput and casework monitoring are well developed. Throughput data demonstrates that staff members are engaging with the component parts of the work in a thoughtful and flexible manner. Casework data is accurately recorded. Although it contains a wealth of qualitative data, it would in this period benefit from a computerised approach to allow analysis to take place. Staff would also benefit from the use of software that would allow for systematic scheduling. The development and application of vigilance levels (as demonstrated in Chapter 2) would assist in planning the multi-client visits that the new centre can accommodate. 4.9 Critical incidents
4.9.1 Technique Critical incidents are used in business planning and represent a technique where staff members are asked to identify specific incidents which they experienced personally and which had an important effect on outcomes. The emphasis is on incidents and context rather than vague opinions. In the operational period of the access centre, several critical incidents influenced the way in which the project addressed certain problems. It is necessary to deal with these in a short review, categorising them by type. 4.9.2 Clients with addiction problems Project staff members have learned to deal with clients (parents) suffering from addiction problems. The key aspect of this problem is to protect the child concerned from further harm. Staff members have been able to identify the signs of continuing drug abuse and have instituted protocols, which deal with issues such as this one. For example, a client using the toilet for intravenous drug use was quickly spotted and the issue was then raised and boundaries enforced.
The client had a history of drug abuse and had an early pregnancy. Following the death of her mother, she made a suicide attempt. Her first child was found to have nonaccidental injuries due to her partner. Now homeless and a heroin user, she was strongly suspected of using (illegal, unidentified) drugs in the premises toilets when visiting with her second child. It was explained to her that she such behaviour could not continue and that she risked cessation of visits [data from centre case notes]
The Access Centre environment provides a container for observing this kind of behaviour, which might otherwise go unnoticed. The onus for adhering to standards of behaviour in this case lies with the parent concerned. 4.9.3 Clients who arrive under the influence of alcohol and drugs In common with the issue raised above, clients who arrive at the centre, who are discernibly under the influence of alcohol or drugs are excluded from that appointment. The issue is reported to the appropriate social worker and the visiting plan revised. The issue is explained to the parent who must comply with basic visiting requirements. In extremis, any parent found using drugs on the premises must be warned that this is an offence and may be reported to the appropriate authorities. 4.9.4 Clients who arrive at the centre accompanied by unauthorised persons: Given the chaotic aspects of some clients it is likely that an unauthorised third party may arrive with the parents and seek to join the access visit. This is unacceptable and falls within security protocols. For example, a client’s new boyfriend attempted to join her access visits but was excluded. Thereafter he would stand around the corner, out of sight. Subsequent domestic violence to the client necessitated a hospital visit, which had to be supported by the Centre staff. This reinforces the need for good security protocols. In this case, the front door was adapted such that clients (and others) could not see inside the building, but could be identified from within. Whereas this is difficult in a neighbourhood domestic setting, a purpose build centre will offer more protection. 4.9.5 Family members who “act out” within the Centre A problem associated with large families is the presence of siblings who are tempted to act out. Faced with this conduct, the parent is requested, encouraged and assisted by the centre staff in dealing with the problem. Yet in so doing she may become distracted from the task of improving contact with her child. This type of conduct may be impossible to eliminate but it is very time consuming and demanding of staff resources. The presence of a large number of siblings may place heavy safety demands on the premises. A solution is to make a space where numbers visiting can be appropriately controlled. Play diversions are a useful resource in this regard and should be considered when allocating resources to a centre. 4.9.6 Theft Given certain aspects associated with the client group, the occasional security breach is likely. This is more likely to come from associates of the visiting parents who have perhaps identified valuable objects as saleable. It is therefore necessary to locate office resources in a discrete, bounded space, which demonstrates that certain security measures are in operation. Casework documentation (paper) must be secured in locked cabinets and client information held on computer should be subject to encryption. However, it is also necessary to avoid an overt display of security that may threaten the atmosphere of the centre. For example, resources located within parent-child visiting space should not appear secured.
46 4.9.7 Lessons The project seeks a balance between the needs of the child and the value of family permanence. Currently, a short case history and a copy of the Care Plan should accompany referral requests. The study supports the adoption of risk assessment protocols prior to the commencement of access visits for any particular case. These should form part of the visiting plan for individual cases. Clients should be not only assessed for violent behaviour characteristics but also for likelihood of substance abuse and any demonstration of criminal proclivities. Often these may be related to each other. An enhanced safety-risk assessment7 for each client should be integrated into both care and visiting plans. For this reason, it is advisable that the Centre Manager has full access to computerised social work records (Social Work Information System – SWIS8) such that arrangements may be put in place to protect the child from any further harm in the course of visitation. Further, it is necessary in cases where harm may result to children that the other agencies shall be included in information sharing. For example, following the Protection of Children Act 2003 (Scotland), the following statement from the Scottish Office makes explicit the following:
(In) acting to protect a child, including making inquiries into allegations that a child has been harmed, agencies should avoid causing the child undue distress or adding unnecessarily to any harm already suffered by the child. Agencies should make sure that children who may be at risk of significant harm receive the highest priority and a speedy response to their problems. All agencies providing services and support to children and their families should have an understanding of the other agencies’ roles, responsibilities and legal powers, and should share information about the 9 circumstances and needs of any child and the family where necessary . [author’s emphasis]
This duty is all the more important for internal agencies that adhere to the protocols of the HSE and having a duty to internal customers (social workers) within the department. Additionally, Children First10 states quite clearly that the willingness to exchange information promptly will be required from all professionals who are involved with the child. 4.10 Flowcharts The following charts show the current referral flow and the phases of development in the life of the Access Centre Project:
Social workers generally carry out a risk assessment as part of the child welfare approach. This kind of assessment should be restricted to dealing with on premises safety and risk. Conceptual models which attach a numerical value to various aspects of the supervised visitation process are available such as described in Sylvia J. Ansay and Daniel F. Perkins, Integrating Family Visitation and Risk Evaluation: A Practical Bonding Model for Decision Makers, Family Relations: Vol. 50, No. 3, pp. 220–229. 8 SWIS has seen considerable difficulties within the last few years and this is examined in the Review of Adequacy of Child and Family Services, Northern Health Board, 2004. Primary problems are the ageing computer server and staffing shortages. www.hsenorthernarea.ie/docs/Adequacy_Report_2004.pdf . Compliance with the Action Plan for Implementing the Child Care Framework in the Northern Area is essential.
Details can be found at http://www.scotland.gov.uk/library/documents-w3/pch-05.htm. Children First; National Guidelines for the Protection of Children and Welfare of Children, Dept of Health and Children, The Stationery Office, Sept, 1999
Current Access Referral flow
Informal Child Placed in Care Residential Fostered
35% of total 10% of total 55% of total
Access requirements formulated
Visiting Plan formulated
Outline Visiting plan
Vigilance Visiting Plan
Outline Visiting plan
Closely Supervised visits deemed necessary
Operational Responsibility of Access Workers
Access Centre deemed necessary
Operational Responsibility of Social Workers
Work with child(ren) Work with parents/s Work with fosterers Liaise with staff
Close supervision no longer appropropriate
Access Centre Project - phases of development
WITHIN BOARD FORMULATION
St affi ng& Pr em ises r eq uir em ent s est abli sh ed
Coor dinat or wor ks fr om exist ing social servi ces p r em ises
1. refines referral protocols 2. sets out criteria 3. staffing levels
PREMISES LOCATED MANAGER APPOINTED MANAGER MOVES IN TO PREMISES STAFFING: FIRST APPOINTMENT TAKES UP POST
Pr em i ses exam i ned for su it abi lit y and m odifi cat i on needs 1. 2. 3. 4. Reinst at em ent : r ep air dam age Bui ldi ng m odi ficat ions st ar t ed Resou r ce al locat ion st ar t s St affing p rocess com m ences
DELAY Decant existing tenant
DELAY Ext. restrictions halt staffing process
ACCESS VISITS START
1. Transport protocols initiated & tested 2. Resource levels improved 3. Caseload & referral system established
STAFF EXPANSION TEMP COVER
1. Dedicated vehicle refines transport 2. New protocols implemented
PURPOSE BUILT CENTRE PLANS UNVEILED
1. Liaison with architect & premises management 2. Modifications reviewed and accepted 3. Further appointments identified.
Placed in recruitment process
PURPOSE BUILT UNIT CONSTRUCTED
1. Decanting initiated 2. Modications to completed unit necessary 3. Problems identified and resolved
PURPOSE BUILT UNIT READY FOR MOVE
Application of a consumer model
5.1 Introduction In this chapter the consumer model as outlined in Chapter 1 is applied to the Access Centre introduction. The indicators below are displayed in tabular form as a reminder. A fuller explanation is outlined in Chapter 1. In this case the key service user is the parent or parents. Children also use the service and will be considered given age appropriate criteria. Fosterers form the remaining service users – although their role as service users is bounded by the needs of the child and parent. Although in some respects social workers are service users (they refer on to a service within a broader service structure), this model locates Health Board staff as service suppliers. As such they are not part of this model. Their needs shall be considered later in this chapter. Necessarily, this approach examines the service user’s point of view and attempts to hear their voice. 11 Table 12: Consumer-orientated indicator system
5.2 Indicators in context: Accessibility: The legal process fundamentally underwrites the position of parents and children within this setting. Where the children are subject to a court order, children are in the care of the Health Board. Parents can then avail of the service and may encouraged so to do. How does this affect service accessibility? Parents are not forced to see their children following care proceedings, although they generally voice a desire to maintain contact. They may or may not exercise their rights to contact. Thus accessibility in this context concerns the ability of the parent to respond to contact facilitation. The desired outcome is contact maintenance, with a view to the permanent return of the child to his/her parental home.
A UK governmental response to this approach may be found at http://www.publications.parliament.uk/ pa/cm200405/cmselect/cmpubadm/49/49i.pdf
50 Choice: The choice that can be extended to parents and children within this setting is also bounded. The alternatives available to parents are limited. Children and fosterers have little choice but to comply with the service delivery system. Choice will be explored with regard to the overall community and voluntary escort provision. The exercising of parental choice through non-compliance lies outside the service objective. It is a choice that requires investigation because of the personal and psychological consequences Voice: The parents and children are subject to legal considerations, which limit the impact they may make on service delivery. Yet it remains important that parents, children and fosterers can make recommendations about how the service is delivered and what it means to them. The study will particularly focus on the voice of the child since in general this tends to be neglected. Current policy demands that the voice of the child be recognised and integrated into service delivery. Accountability: There are clear links of accountability associated with the service. They may, however, be unclear to the parents. This question is related to open government. How aware are parents, fosterers and children of accountability criteria within the state system? Are they in a position to find out? If not, how can this be made more accessible? 5.3 Indicator 1: Accessibility In this study, access is gauged by: 1) The manner in which the parent, child and fosterer can access (be admitted to) the service. 2) The manner in which the parent, child and fosterer can physically access the site or sites where the service is delivered. 3) The manner in which accessibility is promoted through the service’s physical location within a wider context. 4) The manner in which the service is accessible at the psychological-emotional level. Access to the service is fundamentally determined by the social worker responsible for the case - either personally or through a designated Access Worker. Formerly, access has either taken place on social work premises or at an independent location selected by the caseworker in liaison with parent and fosterer. The parent must fit into the legally sanctioned procedure. The study finds that provision of an Access Centre has extended choice to parents. Prior to Access centre service introduction, parents either: 1) Responded to an appointment at a Health Board office where the social worker would supervise contact. This could include accompanying parents and children to resources outside the office such as shops, public sector provision (parks, gardens, zoos, swimming pools) or private sector leisure provision (cinemas, entertainment centres). Merely going for a walk could provide the focus for this provision. 2) Responded to a visit by a caseworker at an independent location at some distance from a Health Board office. This option demanded considerable caseworker resources in terms of travel hours and associated expenses.
51 Parents and foster carers consulted during this study expressed general satisfaction with the service and exhibited a clear preference for the Access Centre service. Dissatisfaction was expressed regarding visits located at Health Board offices such as Mountjoy Square because they were regarded as austere, slightly threatening and too visible. The latter point is important because of perceived stigma and nonconfidentiality. Perhaps because of a lack of personal transport and experience of delays in the public system, the parents’ group regard travel arrangements as complicated and any change of location and travel induces anxiety. The permanence and perceived stability of the Access Centre was therefore regarded as rendering the service more accessible and “usable”. One parent commented:
The Centre is OK but the service came too late for me and my daughter. It will probably help some other people, I hope. [Parent]
Children clearly enjoyed going to and using the Centre. Although their visits could be traumatic this was generally confined to the aftermath of a visit when partings create emotional suffering. It is unlikely that this can be avoided and its management is one of limitation of distress. The provision of the transport system for picking up and delivering children to and from the foster carer’s home clearly offers emotional accessibility to the child in care. It was clear that the introduction of a centre-sponsored transport system improved accessibility for foster carers. Consultation with foster carers revealed anxieties connected with the collection of their foster children - particularly where their own children had to be present (e.g. after school). In the aftermath situation, the distress of the child in care caused by parting with the birth parents, proved extremely upsetting to the fosterer’s own (birth) children. Those introducing an Access Centre should be aware of the delicate nature of the aftermath period. Foster carers and their children can be removed from the aftermath scenario through availability of an independent transport system, a provision that offers emotional protection for the children of foster carers. In consultation, foster parents identified this aspect as beneficial for their foster children An examination of the current building in terms of location is necessary since the study does not cover the period of entry into the new building. The purpose built unit and its (projected) accessibility will be examined at the end of the chapter. Location and exterior: The location, look and layout of the selected premises can be advantageous or disadvantageous for visitation. Any introduction of a centre must seek to balance both. The main benefit of the premises under review was its setting. As a traditional house in a suburban street, it offered a sense of normality to clients. The house can be accessed without fear of stigma. The parent appears to the outside world as an individual calling at a house. This feature was highly regarded by parents consulted. The house had the advantage of lying on a bus route. Despite a poor to medium service, it is possible to reach easily in a single journey from the Quays in central Dublin. For the most part, the maximum number of changes en route would be limited to one. The district in which the centre is located is relatively free from heavy traffic. The centre lies at a junction served by traffic lights. Pedestrians can cross roads in relative safety.
The proximity of shops, cafes and other resources offer an accessible visiting framework. Using the centre as a base, parents and children can be accompanied to the shops for brief periods. This gave parents the chance to shop with their children and purchase small items or food. Additionally, the position of the Centre within a small but vibrant neighbourhood allows for chance activities, which proves beneficial. For example, the local community centre occasionally provides premises for market researchers and on one occasion (observed by the consultant) a parent and child accompanied by the access worker were able to take part in market research. This provided an element of social training for the parent concerned and she welcomed the small fee provided. Organisations seeking to establish an Access Centre should ensure that it lies close to a judicious mix of public and private facilities. Table 13: Criteria for the exterior of the building display
This Centre Yes Yes Medium Some -varies Mostly No Some Some Limited Yes Yes Yes
Criteria: Exterior Does the Centre look accessible? Does the Centre look institutional? Does the area have decent street lighting? Is there heavy traffic close to the centre? Are the premises easily accessible by public transport? Can the parent be easily identified as a “welfare client” Does the Centre have any dedicated parking? Does Centre offer any defensible space? Can staff easily see the surrounding area? Can client callers be seen by staff? Is the centre near shopping facilities? Are there nearby facilities offering social and learning value for parent and child?
Security arrangements were constrained. The premises were more vulnerable than a purpose built premises. There was some defensible space in front of the building, but the house was fairly open. Chance callers could be expected as in any street. Care had to be taken to ensure that the caller was bone fide and not accompanied by others (such as “boyfriends” or others with no access rights) Interior: The house in which the Centre is currently located offers few obvious barriers. Such barriers as do exist are unobtrusive. This (necessary) lack of “gate keeping” appears to promote a relaxed attitude. It is regarded a “homely” by parents and children consulted. With a traditional layout of entrance halls, leading to a stairway, front office, rear access room/kitchen and two upstairs access rooms, the premises were non-threatening and the lack of reception space worked well for promoting informality. This was very favourably regarded and was most noticeable to foster carers as follows:
1. The centre is like any other house, which seems more familiar for children rather than an office room. It feels homely and the children are more at ease. I feel we (all) benefit from that. [Foster carer] 2. The centre is warm and fun. All the children are together. It’s next best to being at home with the parents. [Foster carer] 3. It is a wonderful service because it secures a family home environment for children. It’s a secure meeting place.[Foster carer]
53 Parents consulted said that it was like visiting a normal house. This element must be borne in mind for purpose built premises. Organisations introducing a purpose built centre should ensure the provision of adequate non-office space and reception facilities should appear as non-threatening and friendly as possible such that parent/s and children feel comfortable. The following constitutes a check list for assessing the interior and garden of the building. Table 14: Criteria for the building interior display
This centre No Mostly Removed No Yes Yes
Yes Yes Yes No
Criteria: Interior and garden Does the entrance look formal-institutional? Can circulation restrictions be put in place child gates etc? Are there any breakable objects such as mirrors and glass? Are the toilets lockable (child safety)? Is the kitchen safe enough? Is there a supply of toys, games, TV, video and DVD, computer and games? Does the garden offer reasonable play area? Can ball be kicked around? Can garden be seen easily from inside – aesthetics? Does the garden have high walls to contain games/footballs etc Does the garden appear overlooked by neighbours
Neighbourhood: It is important to remember that the neighbourhood and its residents form an important part of accessibility. A diplomatic relationship with neighbours is of vital importance. In this case, the Access Centre Manger took considerable care to visit neighbours and to reassure them about the important work of the Centre. The manager was successful in involving neighbours in keeping a watchful eye on the building out of hours and they proved most sensitive in terms of respecting the clients. In consequence, a visit to the Centre could be undertaken without feeling the presence of neighbours or of feeling overlooked in any way. Those introducing an access centre should forge relations with neighbours before occupying the premises and commencing operations. Omitting this task may cause hostility. It is beneficial to regard the neighbours as partners and to encourage mutual respect between neighbours and the centre.
5.4 Indicator 2: Choice Since this is the first centre of its kind in Ireland, choice is obviously limited. It does represent a clear service development and the extension of provision both plugs a gap in service delivery and provides client satisfaction. However, the consumer as taxpayer has a clear interest in the cost of providing the service and there is every indication that the service is cost effective in comparison with previously organised supervision services. The key problem here is the lack of comparable provision; the consumer or client cannot “opt out” of the current system. All parents and foster carers consulted in this exercise expressed satisfaction with the extension of service offered. “It’s just brilliant” was the most favourable comment received. Fosterers were particularly approving of the service. In common with parents they compared the service favourably in comparison with previous visitation experiences.
Yes it’s a definite improvement. I didn’t like the way things were done before. I can talk to (staff) at the centre and they are easy to get in touch with. [Foster Carer]
The baseline service offers options of direct social work or Access Centre provision and this stands as a state-imposed alternative rather than choice. The service user cannot exercise options but those parents consulted who had availed of the first (earlier) option appreciated the extension and development of the service.
I enjoy the opportunity of being able to meet up with my children – so I am glad that the centre exists now because it offers me and my children a choice. [Parent]
Given the examples of international developments, it is likely that this service will expand through both state provision and contracting out to private providers such as Barnardos. At that stage, the service user may prove able to exercise more of a choice of options than hitherto envisaged. Extended choice through partnership models are likely to become more developed in the current period. The introduction of the Access Centre model may therefore be regarded as the precursor of choice in this service area. Importantly, the extension of choice assumes the ability of the service user to respond. It should be recognised that service users are often, due to their personal circumstances, unable to act as more than the recipient of a service. Those seeking introduction of an Access Centre should gauge the ability of their users to respond to provision alternatives and place the service in the wider context of children and family services. The service should also seek to avoid the position where the service-provider’s interests entirely dominate the system. Although subject to legal compliance, the service-user remains a consumer. Service-providers must recognise that the user has a personal and emotional long-term interest in outcomes. The following list of criteria, adapted from UK Government studies, illustrates how choice can improve the service. Looking to the future, choice may be exercised by proxy through the appropriate social worker or access worker. The principle remains the same however. Table 15: Improvement criteria display
Information: Service-users should be provided with the information and advice to enable them to make their choice. Well-informed people will be more satisfied and confident about service quality. Consequences: Choice provides powerful feedback on the quality of services, and in some cases this will be incentive enough to change and improve services. Alternatives: For choice to be an effective mechanism, alternative providers must be available. This report envisages a scenario where there are more providers wishing to develop or extend the service under revue. Choice may effectively lie in this instance within the remit of the caseworker. Entrance and exit: Methods of encouraging new providers to emerge are required. Time limited subsidies to new providers may offer one option.
5.5 Indicator 3: Voice In the section above attention is drawn to the ability of the service user to respond. Unless they are offered a voice they may not be able to find a manner, which gives expression to their autonomy as service users – even where it takes place in legal compliance. The Access Centre has provided a framework within which service users can comment on the service. In addition to this exercise, service users are informally consulted during visits and following completion of supervision at the access centre. Parents and fosterers have been consulted through the introduction of self-completion questionnaires. These are designed to be accessible and reasonably pleasurable to complete. Designed for low literacy levels, these have seen success with parents – even in difficult cases where responses were unexpected. Following up on noncompletion of questionnaires also provides a space for consultation. Although privacy can be somewhat compromised, helping the parents to complete these small surveys offers an opportunity for social training in addition to consultation. Parents have therefore proved able to comment on all aspects of the centre including travel, cancellations, resources and their emotional responses to visits. The self-completion system allowed parents to recognise their own feelings about services. All parents responding to consultation noted both emotionally pleasurable and painful aspects of visits. This system also presents opportunity for information requests. One foster carer asked:
I think I need more information on what to do- like if something happened on the visit that might have upset the children. [Foster carer]
Fosterers play a vital role in the Access Centre system. Although they are constantly involved through Access Worker contact during appointment making and transportation, the questionnaire system also helps them to make a formal input and provides a consultation record. They showed an understanding of the reasons for questions and also appreciated that through this mechanism, staff aimed to improve the service. The Access Centre monitors children’s opinion through observation and play. In this way, staff members are able to integrate children reactions into the development of the centre. For example, it became clear to staff that children liked the stability of the centre in comparison with previous experiences. Children expected to find their favourite toys in the same place as they left them. Staff members were able to introduce a system where allocating accessible storage spaces could fulfil this expectation and ensuring that by routine, children put toys and games away in the same place. Finding that toys remained available where they left them promoted familiarity and stability. It is useful to remember that in matters of computer resources, many children are very sensitive to outdated equipment.
For children of even ten years old, you need up to date equipment in computer software, “Games Ed Interactive” for example. So it would be good for all if modern equipment could be put in place. [Foster carer]
56 It was suggested that equipment of this type should be updated regularly or it will be contrasted unfavourably with schools and home resources. However it is necessary to point out that certain popular games (accessible only through game players such as XBox) are only acceptable where two players are necessary, thus involving the parent. Music should be shared rather than listened to. Individualised mechanisms such as iPods are unsuitable. The report suggests that a games room be allocated for siblings of larger families who tend to act out during a visit. In this case, individual games are appropriate. Children were also allowed a choice of toys for the centre. Introduction of recreational resources should always be carried out in conjunction with children through the use of colourful catalogues, which are, in themselves, pleasurable to read.
5.6 Indicator 4: Accountability Accountability may be regarded as a "cascade” of responsibility. The Department of Health and Children is accountable to its service users (customers), employees, the public (and taxpayers). It may promote this accountability through monitoring, honest explanations and careful decisions. Currently, the ways in which the Access Centre promotes accountability is through: 1) The constant monitoring of service-user opinion in its everyday working practices 2) The soliciting of feedback and other information through surveys 3) The provision of information to service users concerning mutual duties and responsibilities, acceptable user behaviour, child safety and the aims and objectives of the Centre 4) Provision of explanations to service users. For example, in certain circumstances the centre may be unavoidably forced to cancel appointments (staff sickness for example). When such circumstances arise, the centre offers honest explanations to its service users. 5) Through arranging professional staff supervision – usually through a senior social worker – such that careful decisions are made on behalf of service users 6) The promoting of child safety through constant vigilance 7) The provision of a code of ethics such that decision-making is transparent. The Access Centre has, during its inception and operational periods, either provided or developed accountability procedures. Most importantly, it is the clear duty of the Department of Health and Children, through its agent, the Access Centre, to: 1) Ensure that the provision of information to service users is accurate, understandable and routinely delivered. 2) Provide mechanisms to respond to legitimate requests for information from service users 3) Have due regards for the rights of all involved. The right of the parent to maintain contact with children who are out-of-home is the key right in this arena. Its facilitation is a vital activity in ensuring both parent and children rights.
57 4) Provide information that specifies who is responsible for what. What is the responsibility of the social worker vis a vis the Access Centre manager, for example? The service needs to ensure that service user understands information and – especially in the case of ethnic minorities – that linguistic assistance is available from within the Health Board to facilitate understanding. The Centre has developed informal mechanisms for ensuring that information is supplied to service users. Requests for information are routinely processed in a professional manner. Thus current working practices and the subsequent creation of a Code of Practice for the Access Centre has gone some way to providing accountability. The Code of Practice should be made available to all service users including parents, fosterers and social work staff. A further code of practice could be usefully developed outlining accountability to the service user and asking such questions as “in the final analysis where does my loyalty lie?” Does loyalty lie with the child, parent, department, etc?12 However, in the case of (4) above, it is uncertain whether the differing responsibilities of social workers vis a vis Access Workers have been made clear to service users and whether service users understand them. Additionally, the study revealed that social work staff members were unclear about duties regarding the Access Centre. Certainly, they showed a lack of understanding of the necessity for child protection safety procedures currently in place – in particular, the conditions under which an access visit can take place and the number of staff members necessary to facilitate a visit. The above constitutes an important area for development. Intra-departmental lines of communication appear somewhat unclear and lack transparency. It is therefore recommended that those wishing to establish an Access Centre pay particular attention to the relationship between different departments and staff and develop ways in which responsibilities may can be made clear to service users. They must also develop a clear system for referrals and promote an understanding of systems amongst staff and service users.
5.7 The purpose built premises: access This brief addendum addresses the new premises. The premises on inspection proved accessible enough. Its location is slightly away from neighbourhood intrusions and offers some level of confidentiality. Transport links are much as for the pre-existing premises. It is perhaps more difficult to reach by foot following public transport journeys and specific instructions easily understood maps will be required for service users. It has reasonable proximity to shops but lies near busier routes where traffic speed demands more care, especially to ensure children safety. There is adequate space for car parking and taxis may pull into dedicated, marked space in a car park. There is adequate provision of external resources and the continuing development of the nearby Ballymun Centre offers opportunities for trips to the shops. Additionally, there is a network of community facilities nearby, offering opportunities for partnerships to be developed. The availability of Citizen Information and Money
Hugman, R. and Smith, D., (1995), Ethical Issues in Social Work, Routledge, London, pp80-82
58 Advice and Budgeting services in the town centre may benefit service-users. There is an opportunity for links to such services in the interests of the service users (parents). The interior of the building, especially the reception area, is light and airy - but staff will need to work harder to provide the informal relaxed environment previously provided. Clearly any extension of the service places extra demands on staff. Where reception facilities are required, these may be organised such that they do not present a barrier to service users. Naturally a reception desk is administratively necessary. But this can be modified and presented in such a manner as to minimise the barrier. Circulation space needs to be adapted such that the visitation environment does not appear too institutional. Those seeking to introduce a service with a purpose built building should pay attention to lighting, circulation space and the feel of the overall environment. Direct liaison with architects is advisable. Accessibility is somewhat diminished by poor lighting. The reception and resource areas present to the front of the building and visitation rooms with observation facilities lie to the rear. There is less light than previously and the visitation rooms will be in the shade. It is understood that lighting is presently under review and changes are being made. It is vital to ensure that accessibility is promoted through attention to design. The necessity for observation rooms is obvious but accountability demands that observation protocols must be explained clearly to service users. It is understood that these are in development and will be formalised prior to entry to the new premises.
Chapter 6: provision
Synthesis –an assessment of quality in
6.1 Introduction The following chapter represents a synthesis of previous information and an opportunity to take up any outstanding issues that have arisen in the course of the examination. The chapter follows the EU model of quality provision such that this synthesis is grounded in a practical manner that leads to best practice. To summarise, users of the service include children, parents and foster carers. In this orientation, social workers (who avail of the service) are designated as joint service providers. The key quality provision categories covered are as follows: 1. Provision of user-oriented services. Promotion of user involvement and participation 2. Provision of quality systems that are flexible and adaptable 3. Provision of systems that take into account the differential needs of users 4. Provision of frameworks that respond to organisational flexibility 5. Introduction of quality that leads the organisation, rather than costs 6. Adoption of performance targets that allow for qualitative and quantitative feedback 7. Dedication of time and resources for implementation of user orientated systems 8. Provision of continuity of services and funding 9. Engaging in partnerships of service providers 10. Development of culture of innovation, responding to need and requirements 11. Engaging of highly qualified staff able to respond to user needs and development 12. Investment in training and training participation of workers 13. Ensuring equal opportunities between men and are not neglected The evaluation engages with service provision from the end-user perspective. The fundamental question is whether the provision is meeting its objectives and has positive outcomes for the customer. In this system, the outcome is difficult to locate simply because of the lead-in time necessary to establish customer benefit. Without a longitudinal study of parent and child relationships, an overall, lasting benefit is difficult to predict – even though some benefits may be presently recognisable. It is therefore difficult to assess whether the child-parent contact enabled by the service will result in a positive outcome. The following model is therefore based on the accepted principles of service provision, currently pertaining in the field. 6.2 Provision of user-orientated services The introduction of Access Centre provision represents a clear improvement on previous systems. Formerly, social workers, assisted by access workers, took responsibility for supervised visits. They found such functions time-consuming in terms of contact hours and the travel involved. The existence of the Access Centre provided social workers with a referral point for cases requiring vigilance. Additionally, they could avail of the space in the centre to fulfil visits in their own caseload. As throughput figures indicate, travel duties entail much time that could be
60 otherwise dedicated to casework. Over the three-year period under review, the Access Centre has undertaken nearly 3000 hours (half of which were dedicated to travel time), which are effectively removed from social worker direct caseload time. Moreover, the Access Centre represents a body of specialist knowledge regarding child parent contact. For example, it has occasionally proved necessary for Access Centre staff to advise social workers on the handling of child-parent-interaction during visits. This is due to the knowledge that has been built up during careful observation of previous visits. Social work staff members may require to improve their understanding of the new service - in terms of whom they may refer and the protocols necessary to administer the enhanced service. At the same time, parents and foster carers have expressed considerable satisfaction concerning the service. Consultation with parents reveals that they appreciate the following: The permanent location is regarded as a stable point of reference. The resources available within the centre help them to play with the child – there is always something to do. The atmosphere of the centre helps them adjust to a difficult emotional task. The support of staff during visits is recognised as helpful and “for the client”. Those who could compare services (both in Dublin and in the UK) said that the Access Centre was a considerable service improvement. Although they appreciated trips to the zoo or to MacDonald’s, this could not substitute for the availability and support of the new service. In particular the quality of care was appreciated. In response to being consulted on the good aspects of the centre, a client stated
I find that the services are acceptable. But the best thing about the Centre is the care and understanding shown by staff. [Parent]
The consultation offered by questionnaires and follow ups were appreciated by those who participated. Although return rates can be low, usually due to client movement and change in addresses, consultation with those who were still within the service proved welcome. Clients appreciated being asked for their opinion and stated that they felt comfortable in raising issues with the Centre’s staff. Foster carers were unanimous in their approval. The transport system provided was much appreciated as an enhanced accessibility that improved their lives. Overall, the service made a difference to the way in which they could organise family duties. In particular, the collection and delivery of children removed their own (birth) children from the inevitable emotional content of the foster child’s meetings and partings. Consultation with foster carers revealed that previous systems that placed them in contact with the institutional side of welfare services made them uncomfortable. They saw the Access Centre as a friendly and supportive service with which they could engage. They additionally appreciated the advisory function of the service, which they regarded as accessible and knowledgeable. Foster carers were responsive to questionnaires and enquiries and they felt that their opinions could influence the service.
61 6.3 Provision of quality systems that are flexible and adaptable Within the parameters of access work, the Access Centre has developed systems that seek to enhance the work of the social work service and the care system. It has extended opportunities to parents and their out of home children and provides a reference point for the improvement of parent child contact. The Access Centre has over the three years of operation adapted to the existing system. It has been constrained however, by staffing problems, recruitment delays and bottlenecks associated with the acquisition of physical resources. Delays in planning and inception of the new purpose built centre have soaked up considerable resources. Nevertheless, the systems in embryo are well advanced for the developmental phase of operation in a new and innovative service. Systems development include referral protocols, transport provision, child parent supervision and foster carers liaison. Cancellations and travel times have been reduced. Critical incidents have been identified and addressed. Departmental staff supervision shows support and dedication within the parameters of departmental organisation. Remaining systems for development are the streamlining of the booking system, development of vigilance levels (casework intensity), the further development of information systems, implementation of training and update schedules for access staff and community partnership development. All of the foregoing depends on staffing improvements. In liaison with the Health Board, the Access Centre needs to carefully examine staffing and organisation, specifying the exact responsibilities of each worker. The critical factor in staff organisation is the requirement for two members of staff to be present on the premises at all times. This limits the number of possible sessions that can run concurrently. Vigilance levels also have an impact on the number of possible sessions mobilised. Finally, the referral system could be improved through further development of operational links with social workers. Issues associated with social work liaison could be improved through education, training and awareness sessions. 6.4 Provision of systems that take into account the differential needs of users The Access Centre is required to deal with three sets of end users (defined as children, parents and foster carers) and to provide an internal (customer) service to social workers. The centre, through provision of improved transport arrangements has taken into account the specific needs of children and foster carers. By providing a dedicated centre, parents have been provided with a stable contact point through which to maintain contact with their children. Staff members also provide role-modelling examples for parents whose parenting skills require development. Some client parents have been referred to parenting skill-training centres. Several areas require improvement, however. Booking and transport systems would benefit from development through the use of user-orientated software. Although the client group’s cancellation rate is likely to remain high, it is likely that seasonal cancellation rates can be predicted and bookings adjusted. This would not only benefit children and foster carers but also allow for the insertion of staff training into the overall schedule of the centre. Critical incidents reveal that some parents are not in a position to response to contact visit protocols. The introduction of a counselling psychology service would improve this and offer additional support to the end user.
62 Finally, there is evidence that the extended family should be involved in contact. Whilst this has been attempted with particular cases, it has proved difficult to accommodate large families together at a single session. The Access Centre should carefully examine the possibility of separate visits from grandparents and siblings (evidence from the residential care service emphasises the importance of siblings to the child in care). This has the obvious advantage of lower vigilance levels and would provide the out of home child with improved social contact. This is especially important where the child is likely to be eventually placed with another family member, such as an aunt or grandparent. 6.5 Provision of frameworks that respond to organisational flexibility This is one of the most problematic areas for the Access Centre since the statutory nature of the service and the judicial framework on which it depends is by definition inflexible. The organisational position of the Access Centre within the Health Board demands that it complies with the regulations, protocols and procedures existing within the department as a whole. It must also comply with initiatives determined by the government level. The child-centred policy adopted by the Access Centre is in line with government thinking. The possibility of organisational flexibility lies within the framework of the social work department and its relation with community services. European information13 suggests that a new social care system is being introduced in several countries, which will be less controlled by the public sector. This is being driven by two factors (1) policy changes following health sector reform and (2) a shortage of different types of social care. Although several countries have retained responsibility for care in the children sector, such states as the UK have contracted out work to the voluntary sector. Consideration could be given to the existing framework of provision within the community and voluntary sector. The next decade is likely to see a development of purchaser-provider relationships between the state and the third sector in Ireland. It is not unlikely that the provision of access centres may attract the commercial attention of community and voluntary organisations. It is therefore important that the Health Board and the Access Centre set the standards in quality provision, which others must follow in order to achieve funding. Such a development would require skills in contracting out, quality testing and compliance management. The Access Centre model is therefore seen as the in-house template for development in the sector. It will also comprise the major source of skilled management and field workers who are experienced and familiar with the rubric of contact work. 6.7 Introduction of quality that leads the organisation, rather than costs Recent research in European social care provision indicates a need for services to be led by quality rather than cost implications. The Access Centre has evolved a reputation for quality work, based on evidence-based research and practice in the childcare field. To some extent, the development of a quality service has been compromised by cost implications, budget limitations and staff recruitment curtailment. In consequence the training profile of the Access Centre remains low
Lethbridge, Jane, (2005) Care Services in Europe. EPSU. Based on information from the European Foundation for the Improvement in Living and Working Conditions, Dublin, which web publishes an on line casebook at http://www.eurofound.eu.int/areas/health/cases.htm
63 simply because of resource problems. It is essential for service development that training and professional updates are maintained continuously throughout the life of the centre. The Access Centre is currently able to present in an informal manner, which adapts well to the client group. Underlying that presentation is a very hard-edged approach to the efficacy of the service. Staff members are effective in drawing boundaries for client behaviour, which is effectively monitored and dealt with quickly and diplomatically. In consequence, there is little expressed rancour from clients because of the attentiveness and respect they receive. Service quality is a major asset of the Centre, as one foster carer observed.
I think it is a great service where the staff are very helpful and go out of their way to facilitate us. They are non judgemental and deal with the children’s issues in a very professional way. [Foster carer]
Staff members have provided this quality service despite considerable resource limitations. The determining factor in the project is safe and constructive supervision. This has not been compromised by costs. Any temptation to provider the maximum number of visits at the cost of poorer quality work has been resisted. This is important at the development stage since it sets the scene for the future of the service. 6.8 Adoption of performance targets that allow for qualitative and quantitative feedback. The Access Centre has maintained a significant and creditable volume of data concerning clients. It is particularly strong in quantitative data. Although a great deal of throughput data and casework information has been generated, performance targets have not yet been developed. To some extent, qualitative indicators will rely on developments in the field. It is important to note that the Access Centre work depends on the combined efforts of several actors and it is recommended that Access Centre staff, in conjunction with social work professionals originate a template for quality assessment. Although adequate qualitative information exists on a case-by-case basis, this restricts the usefulness of information to reference purposes. Qualitative assessment could focus on length of cases, number of visits, case improvements and case outcomes. This should, as a minimum, be cross-referenced with age, sex, family size and reason for supervision. Access Centre staff could also address the way in which improvement is registered. What factors are used to assess this? A determination of the factors will lead to appropriate indicators, which should then be applied consistently to all cases. A recent emphasis on evidence-based material demands a new approach to targets. Adopting specific targets allows the organisation to check if it is performing adequately. The methodology adopted is important but stress should be place upon maintaining the same method of checking over time. This allows the organisation to determine whether there is any change over specific time periods. It is practically useful where government policy is concerned since governments need to determine change over the life of a specific administration. A useful addition to the quantitative data would be a cost benefit check. This might examine the money saved in social work time, through the work of the Access Centre.
6.9 Dedication of time and resources for implementation of user-orientated systems Since the parent-user in this system does not have a choice of service and may not be in a position to respond, the current method of engagement with clients and the use of self-completion and other questionnaires are, in this case, adequate. It is possible that parent groups exist in the catchment and it may be useful to engage with such groups. This offers either a conduit through which parents might contribute or could constitute a proxy for client parents who may not have communication skills to be involved in this manner. But foster carers can be more involved and the actions of the Access Centre staff members have shown that carers appreciate involvement and participation. Foster carers should be consulted on a regular basis to ensure that the system is catering for their needs and those of the children whom they foster. The voice of child is necessarily weak in the system primarily because of the age of the children concerned. Teenage children can be engaged on a more formal level and the Access Centre can usefully examine was in which this can be carried. This might be carried out on a partnership basis with such organisations as Barnardos. Barnardos regularly consults with children and may be able to offer services in this regard. This would also save on time and resources that should otherwise be dedicated to direct service work. 6.10 Provision of continuity of services and funding This is an important element of quality provision since the user is assured of a dedicated service, which is maintained over time. Certainty of funding assures the client that the service will not be suddenly withdrawn or shifted to another service supplier. The funding of the Access Centre has appeared somewhat uncertain and the original budget appeared rather tight in light of the tasks it was expected to accomplish. Users of the service have the right, as citizens, to be assured of continuity and funding. As a parent user commented:
My child feels safe in the centre and she gets to see the same people every time … but what I would really like is for the same people to pick her up, bring her and drop her off, too [Parent]
The move to the purpose built centre may reassure clients that the service is established. Those who are aware of previous access arrangements and who appreciate the benefits of the new service should be reassured that the service would not be withdrawn. Users should also be made aware of any changes to the service and given due notice of such occurrences. 6.11 Engaging in partnerships of service providers Government policy demands that services develop partnerships in order to provide and develop quality provision. The opportunities for partnership in this case have been few, given the innovative nature of the service. At the informal level, staff members have developed partnerships with appropriate organisations.
65 Looking to future developments, the possibility of other organisations entering this field is fairly high. In such a scenario, the Access Centre model will offer a body of expertise. This presents considerable strength for the Centre and offers a range of benefits for the community overall. 6.12 Development of a culture of innovation, responding to need and requirement Within the framework of the Department of Health and Children, the service constitutes an innovation and responds to the needs and requirements of all the user groups described in this report. To summarise: 1. Social workers – social workers benefit from improved use of time and resources; provision of additional expertise through a specialised function; access to a body of specialist knowledge. 2. Foster carers – foster carers benefit from a specialist service, which offers greater engagement. It meets their needs and requirements through the provision of transport arrangements, thus removing the necessity of delivery and collection of foster children. It removes foster carers from part of the emotional affect, which accompanies child-parent meetings 3. Children - children now have the opportunity of stability in location, familiarity with premises and resources and certainty with regard to the conduct of supervised visits. 4. Parents – parents have stability of location and certainty of conduct. They have improved opportunities through which to make an input regarding service delivery. 6.13 Engaging of highly qualified staff able to respond to user needs and development The Access Centre has been able to engage highly experienced staff, but not without difficulty. A key problem is the small pool of specialist staff currently available at the local, regional and national levels. This is unlikely to change in the short term. The current staff complement is insufficient to provide an environment where staff training and development can take place and there is inadequate cover for leave and sickness. Organisational restructuring could seek to concentrate a higher number of access workers under the management of the Centre. Another difficulty is represented by recruitment criteria. Where a limited market for skilled professionals exists, the length of time required for recruitment needs to be limited. Professionals whose skills are highly valued will go elsewhere, rather than wait for the procedures to be exhausted. Recruitment procedures should be reviewed and streamlined having regard for securing skilled staff. Application of equal opportunities criteria should not necessarily slow the recruitment process. The Human Resources Department should consider this matter, such that they may bring the system into line with the recommendations of the Department’s Quality Customer Services Action Plan, 2005-714.
Download full report at: http://www.dohc.ie/publications/pdf/quality_customer_service_action_plan_2005_2007.pdf
6.14 Investment in training and training participation of workers This is an area of deficiency in the work of the Access Centre. Training can only be provided where there is adequate staffing to cover for absence. Training is a vital necessity in this specialist function. New material in childcare is being generated rapidly and within this framework, staff members need to update their skills regularly. They should also be making a training input across the range of social work functions. 6.15 Ensuring equal opportunities between men and women are not neglected There are two areas of equal opportunities applicable to this case. The first lies in the client area. In general, the female parent takes responsibility for maintaining contact. Male clients are very much in evidence at the Centre, however. The Centre attempts to bring male partners within the scope of the project where possible. Foster carers tend to organise along traditional lines and the female partner takes responsibility for day-to-day family organisation. This is unlikely to change in the short term. The staff composition of the Centre is all-female. This is structured by the current labour pool, which is predominantly female. It appears that this is also unlikely to change in the short term. The Department could make attempts to attract male staff but self-election at the training level, upstream of specialist employment, also remains predominantly female. This presents an opportunity since observation shows that a male presence in the centre makes a difference to some children. This is a matter for intervention at departmental policy level. 6.16 Conclusion The Access Centre is a quality service constrained by limited resources. Although some aspects could be dealt with through financial inputs, organisation, some aspects could be improved by re-organisation of staff and resources at the departmental level. The following chapter will deal with ways in which the service can be improved. The following table summarises the Assessment of Quality in Provision chapter. Readers should also refer to the Customer Quality Action Plan 2005-2007, which is the publicly stated policy for the Department of Health and Children.
Assessment of quality in provision – summary display
Yes: Centre makes efforts to involve users at level of parents and foster carers
Quality in Provision Criteria
1. Provision of user oriented services. Promotion of user involvement and participation 2. Provision of quality systems that are flexible and adaptable 3. Provision of systems that take into account the differential needs of users 4. Provision of frameworks that respond to organisational flexibility 5.Introduction of quality that leads the organisation, rather than costs 6. Adoption of performance targets that allow for qualitative and quantitative feedback 7. Dedication of time and resources for implementation of user orientated systems 8. Provision of continuity of services and funding 9.Engaging in partnerships of service providers
Good - within limitations of client ability to respond. Clear participative strength with expressed satisfaction of the client group Systems adopted are tested and safe. Social work liaison and referral systems require improvement Systems aim to accommodate needs of users whilst not compromising the specialist function Frameworks are bound by professional, ethical considerations. Determining framework is that of the Health Board Quality direct care but overall service limited by staff and physical resource problems led by cost Targets difficult to establish in current framework. Requires determination of performance indicators Greater dedication of time and resources are required to implement user systems Continuity of service and developing framework. Funding more uncertain. Confidentiality of service limits ability to form partnerships. Evidence of informal arrangements as regards physical resources Project highly innovative within a development framework Knowledgeable and committed.
Yes: Quality systems have been developed with due regard to children parents and foster carers Yes: Accurate information provides guidance for different needs Limited: Continual development of Centre but must conform with departmental considerations and mandatory regulations Limited: Provides a quality service curtailed by costs
No: Throughput reporting well developed. Performance targets are in development pending No: Time limited environment prevents
Limited: Service continues at current level. Some uncertainty. No: Not appropriate or possible in current framework but will become necessary
10. Development of culture of innovation, responding to need and requirement 11. Engaging of highly qualified staff able to respond to user needs and development 12 Investment in training and training participation of workers 13. Ensuring equal opportunities not neglected
Yes; Staff members adapt to needs of users and learn from their experiences Yes: Current staff experienced and well trained
No: training opportunities poor and time off difficult under current staffing numbers and organisation Limited: At client level, trend is for woman to take responsibility for children
Training underdeveloped and limited by structure of tasks and staff available At staff level, mainly female labour pool determines staff structure.
7.1 Introduction The evaluation of the centre finds that the Access Centre has achieved its current objectives. Observation of the project development phase as outlined in Chapter 4, and consultation with users demonstrate that the Centre is meeting its objectives for client groups. The previous chapter locates the centre as innovative quality provision that is somewhat constrained by lack of resources. Additionally, analysis of throughput suggests the centre is of increasing importance for internal customers (social workers). The importance of the latter should not be underestimated. Within the overall orientation of access work, the centre promotes reductions in workload within the general portfolio of social work responsibilities, which free social workers to concentrate on casework. Although accompanying children and parents on access visits allows useful observation to take place, general casework pressure tends to render visitation as an ancillary role for social workers. Child-parent access facilitation as a support service is designed to assist reunification of families who are experiencing difficulty and are the subject of legal orders regarding care of children. Maximisation of family links formerly took place in the overall context of social casework, and in consequence the facilitation of access has not necessarily been regarded as a specialist function with its own rubric of procedures. However, maximisation of child and family connections is now regarded as lying somewhat outside traditional case goals of social workers. For example, child safety is the key consideration of access work rather than the casework goal of family reunification. The concern of safety is followed by the objective of creating improvements in family attachments, connectedness and parenting15. Thus our overall examination proceeds from a perspective that regards access work as a specialist function - as outlined in Chapter 3 on the context of introduction. This chapter outlines areas for development and recommendations of the specialist service. It examines changes necessary at project level, within-department level and changes that will accommodate further expansion across Health Board provision. Project development covers the following areas: A. Procedures and protocols: actions necessary to improve access casework, reorganisation, transport, accommodating, broader family linkages, administration, accountability and transparency, ancillary services B. Physical resources: physical resources required to ensure improvements in safety, parent-child interaction and development
Wright, E.L., (2001) Using Visitation to Support Permanency, Child Welfare League of America Press, Washington, pp 4-5 [to be found at http://www.cwla.org/pubs/pubdetails.asp?PUBID=8080 ]
69 C. Staff resources: staff resources required to maintain quality and to ensure the smooth running of the service. Departmental linkages designed to ensure the correct allocation of resources D. Evaluation and monitoring: actions necessary to improve evidencebased measurement of outcomes; process evaluation which improves the project programme, and identifies progress on different levels of goal-setting E. Development: using the current service as a model, actions necessary to extend the service across the Health Board; actions designed to promote partnership working
7.2 Procedures and protocols [A] This section is about improving access. It regards access as an integrated process and examines this in such as a way as it might be improved 7.2.1 Reorganisation Consideration should be given to reorganisation of all catchment access work such that it is co-ordinated centrally. This could involve relocation of catchment access workers to a central base provided by the purpose built centre or based in peripheral offices but reporting to the Access Centre. There are several advantages to this option. Access work would be fairly administrated in terms of prioritisation and distribution. Home and other access work would be centrally coordinated. Records would be centralised in a single office and accessed through the departmental intranet. Knowledge about access work would be transparently available to social workers and other stakeholders as appropriate. Compilation of data of the access function would be enabled in am near that allowed for statistical analysis of overall practice. It is recommended that the overall responsibility for access work should be coordinated through a Principal Access Manager. This is in essence a developmental change, which would require an upgrading of the current access centre manager post rather than a new post. 7.2.2 Transport Transport remains a complex issue since within the transport process lies a significant area of emotional trauma for children. When the child is picked up the visit has started. It does not end until the child is delivered back to the foster carer. In the consultation process, foster carers identified this as a problem area and asked for the person in charge to be maintained. Familiarity is important for the well being of the child. The initial phase of “anticipation” which carries the emotional reactions of the child to a forthcoming visit is contained by the worker, as is the second phase, the “aftermath” of parting from the parent. It is recommended that the transport officer be a professional access worker. In this case, the post holder could also provide cover for access duties. A new post of transport supervisor-driver should be considered. This may prove to be both appropriate and cost effective. Taxis are costly and cannot provide continuity of staff whereas dedicated service offers economy, efficiency, continuity and control. Transport and visits should be coordinated such that costs are minimised. By staggering the appointment schedule, the supervisor-driver can pick up and deliver
70 children to the centre, maintain contact with foster carers and provide continuity and reassurance for the children. This does require careful co-ordination and time management. 7.2.3 Organisational integration Taking the two items above into account, the following chart shows a developed Access Centre framework where access work is centralised within the Community Area overall. It suggests a new system where access work is routed through the access centre and incorporates within it a professionalised transport function. This framework recognises the importance of access work as a specialist discipline and essentially changes the relationship between social workers and the access function. In this system the social worker is an internal customer who is provided with a service. In addition to increasing efficiency, the system outlined is designed to improve transparency and promote accountability.
Proposed organisational structure for access work
ACCESS CENTRE MANAGER ADMIN OFFICER TRANSPORT OFFICER Reception Administration Appointment chasing and follow up Information logging, storage and retrieval Security Supvn.
Anticipation & aftermath (specialist duties) Makes all transport arrangements Carries out transport duties liason
ACCESS WORKER(S) (Outside Visits)
ACCESS CENTRE WORKER Centre Visits (Permanent)
ACCESS CENTRE WORKER Centre Visits (Permanent)
ACCESS CENTRE WORKER Centre Visits (Permanent)
Peripatetic worker - outside visits
Remains on sitefor supervised visits
Remains on sitefor supervised visits
Remains on sitefor supervised visits
7.2.4 Ancillary Services Within best practice models, ancillary services, such as counselling, welfare advice and so on, may be attached to access facilities. This function may be arranged either on site or through various existing welfare providers. Counselling can assist parents in understanding their emotional reactions to the experience of the visit. It may also help them to understand the emotional reactions of the child in the anticipation, visiting
71 and aftermath stages. It also represents an opportunity for partnership working on a contractual basis. It would form part of both the care and visitation plans, compiled in conjunction with the social worker concerned.
7.2.4 Extended family visiting Extended family visiting acknowledges that permanent connection extends to significant others outside the parent-child dyad. These include siblings, grandparents, aunts and uncles. Where a need is expressed on the part of the child to see other members of the family, this might also take place in the Centre. Here, vigilance levels may be decreased always having regard to the specific case history. Where kinship foster care has been part of the care process, maintaining the kinship relations should be considered. This might involve visits where extended family members have access to the child concerned without parents being present. It is necessary to recognise however, that kinship visiting may involve the recapitulation of various family patterns including family rituals, stressors, secrets and loyalties. These patterns are particularly important where some over-involved relationships may have hitherto existed, which tended to undermine the primary parent-child relationship. This requires extra vigilance in terms of placing boundaries on what is said to the child during visits.
Physical Resources [B]
7.3.1 Safety Ensuring child safety can be costly since the application of safety measures is necessarily more rigorous than that generally applicable in a domestic environment. The environment and the resources contained within it must of the highest safety standards. The priority lies in protecting the chid from any further harm. 7.3.2 Play The consultation exercise suggested that parents and foster carers would appreciate more play resources for children. However the onus must be on those play resources, which encourage positive interaction between child and parents. Whilst comments concerning provision of more up-to date computer technology are welcome, it is necessary to avoid situations where the child becomes so individually absorbed that the function of the visit is diminished. Computer games, which offer a multi-player function, are more useful in this regard. Here parents can develop awareness of the cues that signal a child’s limitations or attention span and learn to respond accordingly. Uses of play resources are also useful in promoting an awareness of developmental milestones. Attention should be given to creating a “library” of play resources that relate to the cognitive development of the children attending the centre. Children like to feel that toys are their own and want to find them in the same place as they left them. It is useful to promote this sense of ownership through the provision of adequate, flexible storage facilities. Children may then leave their toys in the designated storage space and collect them there on their next visit. The provision of
72 low-level shelves or cupboards from which children may choose a toy is a suitable arrangement. 7.3.3 Provision for siblings Some attention can be given to provision for siblings where the pressures of visitation may be lowered through the provision of absorbing games that offer diversion. Analysis of critical incidents in the life of the centre indicates that visiting siblings sometimes find it hard to concentrate and can experience a drift in attention. They may attempt to wander around the building looking for something to interest them. In this respect a dedicated games room designed for older children may represent a useful development opportunity. Where a room is free from scheduled visits for example, this offers the opportunity for siblings to play under minimum supervision.
7.4 Staff resources [C] The current resourcing of the access centre is restricted by numbers of available staff. Case throughput is limited by child safety considerations, which are directly related to close supervision. It is therefore necessary to accurately assess the appropriate staffing levels and the supervision necessary to facilitate their work. The chart above offers one option, which depends on the availability of a manager and administrative back up. The following two posts would be essential for the smooth running of the centre’s work. In the organisational chart above, the centralisation of the access function can render the whole system more efficient but places additional demands on the manager’s post. 7.4.1 Access Manager Managerial administration constitutes the vital factor in: 1. Policy role in extension (roll out) of the service 2. Maintaining a quality service 3. Selecting, distributing and coordinating cases 4. Staff supervision and workload distribution 5. Social work casework liaison 6. Maximisation of visits 7. Ensuring compliance with centre casework protocols 8. Ensuring that regular staff training and updates take place 9. Ensuring compliance with health and safety regulations 10. Ensuring the development and maintenance of outcome measurements 11. Ensuring the continuing development of the centre 12. Building relationships with the community 13. Financial control As such, the current Access Centre Manager post should be removed from client or observation duties in order to give full attention to the above tasks. Secretarial and administrative assistance should be introduced to ensure that management duties are fully implemented. The manager post should be upgraded to accommodate the extension of the service and to include a policy remit that includes dissemination and development duties beyond the centre. The post would be renamed as Access Manager.
73 7.4.2 Reception/administrative worker The introduction of a reception area necessitates an additional administrative post, which should include the following duties: 1. Coordination of visits including logging of bookings and cancellations 2. Booking of appointments with internal and external agency staff. 3. Liaison with parents and foster carers to ensure maximisation of visiting schedules. 4. Liaison with social workers to ensure adherence to referral protocols. 5. Reception of parents, foster carers, children to the centre. 6. Maintaining of statistics; storage and retrieval of relevant data. 7. Administration of telephone and email communications. 8. Maintenance of accounts and data necessary for the smooth running of the centre. 9. General office duties such as filing, photocopying, maintaining coordinated diaries, etc. 10. Security duties such as maintaining a record of persons on the premises; supervising the security function and general surveillance of the building. This post should report to the Centre Manager and perform support tasks for all access staff. This post is identified in the proposed organisation structure represented in Chart 6 above. 7.4.3 Porter In a building of this size, demands assistance for various functions. The primary purpose of a (non-uniformed) porter is to maintain a discreet presence in the building. This will enhance the security function whilst obviating the need for a security officer. The porter duties should include: 1. General patrol duties in and around the perimeter of the premises including parking of vehicles 2. Video monitoring (outside of the access room observation function, which is an access worker duty). 3. Monitoring of security arrangements both within and outside the building (including parking). 4. Maintaining a link with police, fire and ambulance services 5. Lifting and transporting office equipment, play resources, files. 6. Receiving and despatching of any goods. 7. Assisting or facilitating any disabled adult or child where necessary. 8. Support in any situation deemed likely to cause physical harm to a member of staff. 9. General duties such as attending to alarms, central heating and other appliances. Arranging for necessary repairs to equipment or the building and supervising such repairs. 10. Opening and closing the building.
74 7.5 Evaluation and Monitoring [D] Current evaluation and monitoring are satisfactory but can be further improved. In particular, outcome measurement needs to be developed. This will depend on a rigorous attitude towards case progress and the manner in which cases end. When the case is closed what has happened in terms of the objectives of the centre. Has permanence increased? Has the child developed in accordance with established criteria? Are parents better equipped to perform paternal roles? 7.5.1 Process Evaluation Process evaluation documents the implementation of the service and monitors any changes that may improve the system overall, much as this examination has done. It should necessarily comprise the examination of the following items. 1. 2. 3. 4. 5. 6. Services provided Demographics – client characteristics Staff development Throughput statistics including participation and “no shows” Client information data including descriptive information Feedback from all stakeholders including social workers, children, parents, foster carers - through interviews, focus groups, project observation and review of data from software
7.5.2 Outcome Measurement Outcome measurement relates to the benefits achieved for participants in the project. In this case, such indicators as the following may be adapted for use. 1. Parents and children are interacting well - in a manner that enhances child development and learning 2. Parents have learned to engage with their children in a responsible manner 3. Ability of the parents to identify and respond to the needs of the child 4. Absence of the child’s need to gratify the parent 5. Assessment of the quality of attachment 6. Children are safe 7. Children are healthy 8. Families access formal and informal support structures to meet their needs 9. Children “developmental milestones” are achieved 10. Children developmental problems are identified and addressed 11. Status at exit (case closed) 12. Post programme information gathered after case completion At departmental level, a cost-benefit approach should be adopted comparing programme implementation with alternative approaches. This allows for adjustment of the programme and should underwrite the further extension (or “rolling out”) of the successful model at national level.
75 7.6 Development of the Service [E]
7.6.1 Development Extension of the service to additional catchments should be subject to a cost benefit exercise. This should incorporate an examination of the following elements: A determination of enhanced quality for the primary customers (children, parents, foster carers): Saving of direct social work costs in social work hours, transport time, transport costs Greater transparency in terms of process and outcomes 7.6.2 Partnerships: An examination such as that specified above should necessarily examine what benefits exist in the arena of partnerships and purchaser-provider relationships. If professional voluntary agencies are able to provide services, what criteria should be applied? It would also be important to examine any savings to the department obtained through forging this kind of relationship. Undertaking contracting out will necessitate quality assurance inspections and compliance management together with the associated costs of administering the tendering, selection and review process. Current operational methods and standards within the sector imply that relationships with the community and opportunities for partnership working be explored. When considering partnership working, a thorough examination of proposed arrangements must be undertaken to guarantee fair, equitable and transparent service operations. Partnerships should have clear written protocols and ethical boundaries must be incorporated within service agreements. Partnership working is useful only in so far as it provides clear benefits to the end users. Possible providers should be limited to those child centred organisations that can demonstrate proven professional standards and commitment. For example, Barnardos and ISPCC fit within this category. However, broadly based multi-functional organisations may not be able to offer the specialist track record required for this sensitive operational field. It is additionally necessary to recognise that some organisations may pursue any opportunity for secure state funding. This level of generality is inappropriate within the legal framework, duties and responsibilities pertaining to supervised children cases. The key priorities must remain a focus on the benefits to the child and the rigorous application of safety procedures. Another option may be to limit partnership working to segments of access work. Transport could be undertaken by a partner organisation (always having regard to the professional status of staff accompanying children to their supervised sessions). The voluntary sector may be able to provide supplementary services however. For example where parents find it difficult to reach an access centre, they might be assisted by voluntary organisations in the community. Evidence exists to suggest that there is a relationship between the time taken to both reach and return from a centre and the likelihood of attendance This might have the advantage of securing parental compliance with visiting schedule and render casework scheduling more effective. Although this may tend to compromise the parents independent wish to see their
76 child, it is essence the child (as the key service customer) who benefits. In this case the voluntary escort enhances the existing service. The voluntary sector may also be able to provide counselling services either at the centre, at nearby local venues or closer to the parents current home (which may be outside the catchment). This service enhancement constitutes a matter for further exploration.
8.1 The report begins by outlining the aims of the evaluation, the structure of the study and the methods employed. The report aims to provide both a service evaluation and a Vademecum (manual for introduction and extension of the service). This chapter lays down definitions and terms employed in this report. The chapter goes on to describe the multi-dimensional approach, which employs a number of methods. These methods include consultation with major stakeholders and customers, using discussions, interviews and self-completion questionnaires. Observation employs basic observation techniques, which include participation in the centre’s activities. In this regard, in order to engage with children as customers, observation was achieved through participation in children activities such as play 8.2 The study utilises two models, which employ accepted indicators. In the first method, access choice voice and accountability offer insight into the service from the point of view of service users, placed as consumers. The second follows quality assessment procedures currently standard within EU practice. 8.3 Within the multi-dimensional approach adopted, the study is laid out in the following fashion. Following the introduction, Chapter 2 describes the context within which the service is being introduced – at the legislative and political levels. Chapter 3 offers a comparative dimension and looks at best practice in several states – Australia/new Zealand, the United Kingdom and the United States. It draws out various features, which are appropriate to the introduction of the service currently under investigation. Next, Chapter 4 closely examines the phases of development of the current access centre. This seeks to locate any necessary components and criteria, which should be applied in service development. The Consumer Model is applied in Chapter 5, and is primarily focused on the use of the existing centre. It briefly examines the introduction of the purpose-built centre, which is not in operation at the time of completion of this report. The application of Quality Assessment indicators in Chapter 6 constitutes a synthesis of information gathered during the course of the evaluation. Chapter 7 concludes the report by examining options for development of the centre and the service generally. 8.4 The study examines the political and legislative context at the Ireland state, EU and international levels. It places the Access Centre within the current focus on the child and children’s rights. It finds that the Access Centre is an essential service component in achieving the objectives of the Child Care Act 1991, the Adoption Acts 1988 and 1991, the Children Act 2001 and the fulfilling of state obligations within European and United Nations legislative frameworks. At local level, it also fulfils policy objectives as outlined in Children First (1999) and Strengthening Families for Life (1998). Finally it fulfils Objective L of the National Children Strategy whereby children shall have the opportunity to experience the quality of family life. The various legislative instruments pertaining to child contact are specified in this chapter and links to relevant statutes provided. The services of the Access Centre are found to comply with this legislation. 8.5 The study looks at the comparative dimension through an examination of the specificities of access centres in three areas: Australasia, The United Kingdom and the United States. The report suggests that the Access Centre adopts the vigilance levels
78 specified in the analysis of Australia and New Zealand where services are comparatively well developed. It additionally recommends the adoption of service principles outlined, which cover aspects of safety and of guidance in child-parent interaction. The United States information specifies particular standards that may be applied to access centres in terms of referrals, resources and procedures. In particular, the US experience points to the usefulness of ancillary facilities (such as counselling) that may be integrated within access centre services. However the report also draws attention to the problem of social work “over-referral” in the United States, suggesting the need for clear referral principles. Overall, however, most access services were being provided outside the state sector, normally (but not exclusively) within purchaser-provider relationships. In Ireland, the access centre innovation therefore appears as an example of a state-led initiative, which offers a best practice model for emulation by the third sector generally. 8.6 Chapter 4 deals with the development of the access centre for the original concept through operationalisation to the design of a new purpose built centre. This analysis shows that the centre is a within-service idea, which had potential and credibility. It was supported through the consensual validation of experienced social workers, who saw the development as offering professional enhancement of their work. It was also regarded as an effective and economic alternative to existing processes. The study oriented to future service extension, and tracked the phases of introduction such that delay points and negative incidents could be avoided in the future. The study notes the presence of evidence-based enquiry, which supported the general direction of the centre’s work 8.7 Chapter 4 specifies the establishing of priorities in (1) underwriting child safety and (2) avoidance of further harm. It notes the role of the staff in creating clear professional boundaries and adhering to safety standards of a high order. Analysis of throughput statistics indicate that the centre is instrumental in saving much social work time, which can now be dedicated to other casework duties. Figures also demonstrate that that the staff members have engaged well with referral patterns, reducing absences and no-shows. The study notes the lack of development of outcome measurement. This appears to stem from a lack in human and physical resources. The introduction of specialist software will not only accommodate the production of statistics, but also help manage referrals, transport and visiting. However, increased staffing levels will be required to manage the operation successfully. In particular, transport operations tend to be regarded as a neutral operation whereas it is, in essence, an emotional part of the child’s visiting experience. It should be reviewed as specialist function that deserves both additional staffing and professional expertise. 8.8 The study finds that development of human and physical resources proved slower than necessary and that this was due to causes located within the protocols of the Department. This suggests that in order to facilitate innovation, protocols should be reviewed and improved. This particularly applies to staff appointments, but also to transport and buildings. It is additionally important where children are the focus of innovation. Delays to entry to the existing premises and to the purpose built centre could have been reduced through better communications, improved systems and project management. Staff members were placed in a position of constantly informing parents about a change of venue that, for many of them, never took place. This has clear implications for customer services in terms of access, choice and accountability.
8.9 An analysis of critical incidents showed that the staff members were flexible and proactive in managing the premises and the visitation process. Critical incidents encountered included drug use on the premises, arriving under the influence of alcohol, arriving with unauthorised persons, children (often within large families) who act out within the centre and theft. The experience of those incidents led the staff to create a code of practice, which is attached as Appendix “D”. The study suggests that a safety-risk assessment for each client should be integrated into both care and visiting plans and that the Manager has access to computerised social work records to further facilitate child protection measures. 8.10 Chapter 5 examines the consumer aspects of the Access Centre introduction. The existing Centre was found to be accessible enough and transport was much appreciated by both social workers (internal customers) and foster carers. Parents appreciated the domestic setting of the house for reasons of anonymity and accessibility. In general they compared the centre favourably vis a vis previous arrangements. Children clearly enjoyed being at the premises and were able to play in a relaxed fashion. Parent-child interaction was closely monitored and demonstrated the value of the relaxed but attentive atmosphere facilitated by staff members. This was indicated by the fact that (for example) they fully expected their toys to be in the same place as they left them. They took ownership of the building when present. The study found that the centre offered a precursor of customer choice in that the present circumstances limited options. However, consultation showed that parents appreciated the service. They stressed that they always received the information they required and stated that were treated in a respectful manner. 8.11 Chapter 5 noted that the consultation exercise mobilised by the study gave the service users a measure of “voice” and allowed them to make criticisms and suggestions for improvements. The study suggests that these exercises should form part of the regular protocols of the centre. At the service level, accountability was facilitated through information and consultation. Yet awareness of and understanding of the service by social workers was a little limited – particularly where matters of staffing and child safety was concerned. The study suggests staff awareness training designed to promote the efficiency of referral systems currently in place. Finally, the accessibility of the purpose built centre was briefly examined. The study found that certain aspects of the building were deficient and suggests that improved communications at the design period would have obviated any difficulties. These particularly apply to child safety and to factors relating to the interior ambience of the building, such as lighting. This would have prevented costly remedial measures at a later stage. 8.12 In Chapter 6, the study examines “quality in provision” indicators. It finds that that the service is responding to demonstrable and differential needs in the community and in the social services generally. Yet the Access Centre is a quality service constrained by limited resources. Although some aspects could be dealt with through financial inputs and improved internal organisation, others could be improved by reorganisation of staff and resources at the departmental level. In particular the study finds that staffing requires improvement both in numbers and in training received. Staffing difficulties limit the continuity of service that users/consumers have the right to expect. The study recognises that the pool of available staff is somewhat restricted
80 by factors who’s origin is external to the system under review. The Centre is further limited by a weak relationship with the community and the third sector generally. Again, this is a factor conditioned by the position of the innovation process within a state-led initiative and the constraints of legal requirements. However, the study recognises that staff members made considerable effort to establish broader relationships outside the framework of the department. The study also finds that although the centre is very strong in process measurement, there is a need to establish accurate output measures (case outcomes particularly) and performance targets. It suggests that information systems should be extended accordingly. This would help to demonstrate the effectiveness of the service. 8.13 Chapter 7 examines options for development and makes suggestions for improvements. Whilst the study recognises that the service has met its objectives, it locates several areas in which the service could be enhanced and extended in terms of Procedures and protocols, physical and staff resources, evaluation and monitoring and in further development of the service. The chapter suggests that the access function should be reorganised such that access is centrally administered. The Access centre would in this case be the central referral point for cases and all cases would route through that point. This would offer improvements in efficiently, transparency, accountability and knowledge. The study recognises that transport is not a neutral but a specialist function, which minimises child harm through adequately engaging with the anticipation period of the child’s visit. It is suggests that the transport function should also be centralised and professionally administered under the remit of the Access Centre. A staff reorganisation chart offers a picture of the manner in which the centre might more efficiently achieve its objectives. 8.14 Chapter 7 suggests that play resources be extended within the centre such that parent child interaction constitutes the main focus. The study recognises that children are utilising electronic and computer games at much earlier ages and that listening to music is increasingly a technological function. The report suggests that the focus of the centre must remain the relationship between child and parent. The study suggests that development of ancillary services would enhance the quality of the service. Such services as counselling has a direct bearing on the permanence of relationships and should be strongly considered. Provision for extended family should also be considered. The need for contact with significant others is also important to the well being of the child. 8.15 Chapter 7 examines staffing requirements and suggests that the Access Centre Manager be upgraded to a principal post to accommodate the following change in responsibilities: additional access workers, a transport officer, receptionist and porter and a dissemination and development function. The posts are deemed necessary given the scope of new purpose built centre, the reorganisation and centralisation of access work across the catchment. The necessity of rolling out the service will demand a new policy level input from the manager that orientates outwards to assist in extending the service. 8.16 Chapter 7 examines monitoring and suggests that process measurements are adequate. The report identifies output measurements as requiring development. These would focus on case outcomes and developmental activities successfully completed within the Access Centre programme.
8.17 Chapter 7 looks at the scope for development and extension, suggesting a cost benefit exercise prior to roll out. It briefly examines partnerships and suggests that the importance of the child protection function demands a limitation on partnership activities. The study estimates that purchaser-provider relationships will increase. It recommends that, in this case, access centre work should be restricted to professional organisations with a clear and transparent track record, such as Barnardos and ISPCC.
9.1: It is recommended that the Access Centre be regarded as a best practice model. It is recommended that the plans be drawn up for extending the service following a cost benefit exercise. It is further recommended that the Centre Manager play a central role in disseminating information concerning the value of the service. 9.2 It is recommended that access centre work be rolled out in remaining community care areas, and then at regional and national level, always subject to the adjustments detailed below. 9.3 It is recommended that the position of the Access Centre within the overall HSE structure be changed such that the Centre becomes the Central Access Unit (CAU) for Community Area 7. The system should be reorganised such that all access work, including referrals, is centrally coordinated and distributed at the Central Access Unit. 9.4 It is recommended that within the Access Centre, improvements in staffing be made such that quality services and resources usage be maximised. The appointment of not less than four Access Workers is required to filly utilise the resources of the purpose built centre. 9.5 Given the relocation of the service to the new purpose built centre, it is recommended that support staff be appointed commensurate with the scope of the service and the scale of the building. The appointment of a receptionist/ administrative worker and a porter is deemed necessary. 9.6 It is recommended that the transport function be recognised as a professional service in its own right. It is recommended that child transport become a dedicated service attached to the Access Centre, catering for all Access transport and that this function fall under the remit of the existing Access Centre manager. 9.7 It is recommended that that the post of Access Centre Manager be re-evaluated in the light of the changes detailed above and the remit of the post extended 9.8 It is recommended that staff training be reviewed and extended such that staff members receive regular updates in professional aspects of the work. These may include such development options as: Workload planning Information systems Planning for Permanency Child Development Child Observation Interventions Critical Thinking Pattern Recognition Dealing with Stress Foster care Outcomes Child Safety Hearing the Voice of the Child
9.10 It is recommended that the Access Centre explores the possibility of providing ancillary services at the new purpose built unit, those services to have a direct impact on all customers of the service: children, parents and foster carers. Services such as counselling, family therapy etc., would add value to the current service 9.11 It is recommended that the Access Centre anticipate likely developments in purchaser-provider relationships and forge links with third sector organisations with a view to enabling partnerships, which may mobilise resources and achieve common objectives. It is however recommended that any partnership involving direct children work be restricted to experienced organisations such as Barnardos and the ISPCC. 9.12 The report recommends the introduction of vigilance levels to be applied to all cases. These levels should be anchored in a manner similar to the levels evolved in the New Zealand and Australia case studies in Chapter 3. 9.13 The report recommends that elements of Risk Assessment be quantified and integrated into current visiting plans, using numerical ratings that determine the allocation of resources to particular cases. 9.14 It is recommended that resources that maximise child –parent interaction be subject to review and development. This should include any play resources located in the Centre. The report recommends that this function be recognised as a key function within access centre work and budgeted accordingly. 9.15 The report recommends the development of outcome measurement for all cases. These may comprise of a set of outcome indicators measuring the achievements of a series of access visits but must ultimately address case conclusion outcomes. The report recommends the acquisition of specialist software to accommodate this function and other tasks (including scheduling and resource allocation). The report recommends the continued use of such instruments as were developed during this evaluation project, to hear the voice of its customers. These may also be integrated into process and outcome measurement systems. 9.16 The report recommends that as far as is practicable, the Centre develops further formal means of hearing the Voice of the Child and integrates these into Visiting Plans. Further, that the Centre extends the consumer perspective, which locates parents and foster carers (external customers) and social workers (internal customers) as consumers with a range of available options and choices.
APPENDIX “A”: DESCRIPTION OF SERVICE
What Is An Access Centre?
The Access Centre provides a welcoming place for children looked after away from home, to have healthy contact visits with their parents in a safe and child centred environment.
Purpose of Access:
The primary purpose of visiting is to allow children to preserve relationships with people who are important to them. Effective access is an essential part of the process in any future planning for children.
The Role of The Access Centre Staff:
The Access Centre is staffed by a Manager and 2 qualified Child Care Workers. All access visits are supervised by a staff member. Supervision may take the form of discreet observation at a distance, or involve active participation by the supervisor to encourage interaction, or to ensure a child’s safety. The Centre will (in as far as possible) strive to achieve consistency by attempting to assign the same worker to supervise all sessions that take place with individual children and their families.
The access house has two comfortable well equipped visiting rooms, with a wide range of games, toys, activities etc. to cater for children of all age groups. Children and their families are welcome to light refreshments, e.g. tea/ coffee, soft drinks during their visits.
The Access Centre is open on Monday, Tuesday, Wednesday, Friday from 10.00 am to 5.30pm, and on Thursday from 10.00 am to 6.30 p.m.
The Access Centre is situated at 29A Kilmore Road, Artane, Dublin 5, Tel.No. 01.8478124 Dublin Bus serves the Artane area, with bus routes 20B to and from the city centre, and 17A/103 to and from Ballymun and Santry.
Appendix “B”: DRAFT CODE OF PRACTICE
This code of practice seeks to account for all likely experiences during referral process, visits and different outcomes of the Access Centre activities. It seeks to lay down the formal principles under which Access Centre staff members operate. 1. Clear arrangements for a child whose parents are estranged must be made such that the child does not unduly suffer. This may include restricting visits of one or other of the parents. The Access Centre shall however be cognisant of the child’s wishes to see both parents, always bearing in mind the safety and well being of the child. 2. In interests of the child’s safety, Access Centre staff may have to control, restrict or suspend visits. In particular, where a parent is clearly deemed to be verbally or physically abusive or under the influence of alcohol or drugs, admission may be refused and the visit postponed. 3. The Access Centre shall avoid delay in respect of matters relating to children. This is especially damaging in the case of very small children, where even temporary breaks with parents can be detrimental. 4. Having regard to the age of the child, the child’s wishes should be respected. The Centre strives to listen to the child. This is especially important where the child expresses an unwillingness to see the parent or parents. The child’s feelings may change however and the Access Centre therefore strives to keep relationships and arrangements open. 5. The Access Centre aims to provide a constant review beyond the statutory review process. The Centre will seek to confirm whether arrangements are working or if they are too restrictive. The Access Centre will monitor difficulties and identify necessary changes. Any changes shall be discussed in the first instance with the referrer. 6. In the event that the Access Centre staff detects that parents are "drifting away" from the child, staff will point out, to the parents, the long-term implications for the child. 7. The Access Centre staff shall maintain clear and effective liaison within the service on all access arrangements. Recommendations on suspension or limitation of access shall be addressed to the appropriate Social Worker 8. The Access Centre staff shall explain to the parents any change in access visits or procedures and confirm this in writing. Access limitations and access postponement shall be discussed with the appropriate social worker and conveyed to the parents in writing together with reasons.
86 9. Should the Access Centre staff be forced to cancel or postpone access visits for operational reasons, the staff shall contact the parents in a timely fashion and mutually agree a new appointment. 10. The Access Centre shall maintain full and clear records for the effective monitoring and evaluation of access visits. 11. The Access Centre aims to ensure that foster parents are made aware of the need for effective relationships between the child and birth parents. The Access Centre will liaise with foster parents on any matters pertaining to the child’s welfare, which arise from experience during access. 12. The Access Centre shall take all reasonable action to ensure that transport is provided for the child in a manner that limits any emotional harm to the child caused by reunions and partings. 13. The Access Centre staff will provide a congenial welcome for children, parents and other relevant parties in the Access Centre venue. The Access Centre staff will encourage parents to participate in the child’s life. This might include preparing meals, making drinks, shopping for clothes or preparing the child for a sleep. 14. The staff shall facilitate the parent in visiting the Access Centre to an extent that will not compromise the personal autonomy or development of the parent. The staff will advise the parents concerning directions and transport to the Centre and endeavour to ensure that parents do not arrive late for appointments. 15. The Access Centre understands that parents shall have the right to complaint about access and that they are able to ask for a review of decisions. The staff shall inform parents and others users of the centre about complaints procedures pertaining within the Health Board. 16. Unexpected crises may occur, necessitating suspension of access to protect the child. If a crisis occurs the centre will terminate appointments. The relevant social worker shall be informed with a view to a joint review of termination to take place between social worker and Access Centre staff. 17. Where continuous observation is necessary. Access Centre staff will appraise the parents of the reasons for such a safeguard. Parents may inspect any facilities such as two way mirrors, observation rooms and so on. 18. The Access Centre strives to ensure the safety of the child. However, if an act of child abuse occurs on the premises (shouting, threatening, hitting) the staff shall terminate the appointment. Depending on the severity, the Access Centre may have no option but to inform the
87 Gardai. The parents shall be informed in writing of reasons why this occurred 19. In the event of any non-accidental injury occurring to a child on the premises, the staff shall terminate the visit and suspend access, prior to an investigation. The parents shall be informed in writing. In the event of accidental injury, the staff shall take all necessary steps to ensure the welfare of the injured party. Staff shall make the necessary report and enter it in the appropriate health and safety records. 20. If a child becomes ill at the Access Centre, the staff shall take appropriate action to ensure the safety and well being of the child. 21. If a child refuses to engage with the parent/s, the staff shall take all necessary action to persuade the parties that continuing the relationship is beneficial. If this cannot be achieved the relevant social worker shall be informed of the situation with a view to deciding appropriate action. 22. Visits to the Access Centre outside of the scheduled appointments shall generally be discouraged. At the same time, the Access Centre wishes to encourage a friendly relationship between parents and staff. "Dropping in" will therefore be at the discretion of the management. 23. Access Centre staff shall not admit any person to the premises whom they believe is likely to harm a child, parent or member of staff. 24. The Access Centre will take all reasonable action to ensure the privacy of visits for the child and his or her family. 25. The Access Centre staff shall endeavour to monitor welfare practice and childcare, development, suggesting training, changes to practice or procedures or compliance with safety regulations pertaining to children.
Appendix “C”: PARENTS’ QUESTIONNAIRE
What do YOU think about the Access Centre?
About this form … We need your point of view. It will help to make the service better Your answers are private and confidential. No name is required. Don’t worry about spelling. It is your answers that are important. There are NO “right” or “wrong” answers – it’s YOUR opinion. We want you to be as honest as you can be. If you have any problems, ask a friend or someone you trust to help you.
1. Children’s ages:(write in) Boys __________ Girls _________
2. How long have you been using the access centre? Please tick (√) ONE answer a) b) c) d) e) Between 1 month and 3 months Between 3 months and 6 months Between 6 months and 9 months Between 9 months and one year More than one year
3. How do you normally GET to the centre? Please tick (√) ONE answer. a) b) c) d) e) I come by bus I come by car I come by train I walk Mixture of ways (Please write in) ______________________
4. Please tick (√) ONE of the following answers: a) Getting to the Centre is easy b) Getting to the Centre is hard 5. Do you have any problems with GETTING TO the centre? Tick (√) ONE answer that you agree with a) No, never b) Yes,always c) Sometimes (Please say why it’s difficult ________) (Please say what happens _________)
6. How do you FEEL at the centre? Tick (√) as MANY answers as you like. I feel welcome I feel unwelcome I feel relaxed I feel anxious I feel safe I feel watched I feel happy I feel forced to come I feel supported Any other feelings? Please write in __________________ 7. How do your children like the centre? Tick (√) as MANY as you like They like being at the centre They don’t like being there They find it upsetting They find it good fun They hate it when they leave It’s a mixture of things 8. What are the GOOD THINGS about the centre? Please write in. _______________________________________ _______________________________________ 9. What are the BAD THINGS about the centre? Please write in. _______________________________________ _______________________________________
Is there anything that would make the centre better for YOU and your children? What would you CHANGE? Tick (√) AS MANY as you like. I would like … a) More space/rooms in centre b) Different travel arrangements c) More activities d) More play, games and toys e) Good weather activities f) Bad weather activities g) More staff
Do you feel comfortable with asking the staff questions? Tick (√) ONE answer you agree with. a) b) c) d) Yes, I always can No, I never can I sometimes can Don’t like to bother them
Sometimes staff have to cancel your visit. When it happens, how do you FEEL? Tick (√) ONE answer you agree with. a) b) c) d) It is a disappointment It is OK. It is upsetting I don’t mind
Sometimes YOU have to cancel YOUR visit. How do you get on? Tick (√) ONE answer you agree with. a) b) c) d) e) I feel bad about it It doesn’t matter It is necessary sometimes It can’t be avoided I may have to be at home
Do you think staff give you enough INFORMATION? Tick (√) ONE answer you agree with. a) It is OK as it is at the minute b) They give too much information c) No, I need more information
(Please write in what kind of information you need) __________________________
15. Sometimes you have to get in touch with the Centre. How do you get on? Tick (√) ONE you agree with a) b) c) d) 16 It is OK It can be hard to get in touch I don’t like leaving messages At times I run out of phone credit
How do YOU FEEL after a visit to the Access Centre? Please TICK (√) as MANY as you like. a) b) c) d) e) f) g) h) i) j) Dreadful Happy Tired Tearful Hopeful Sad Frustrated Annoyed Satisfied Nervous
Have a look at these statements underneath. TICK (√) ONE answer you agree with. a) I look forward to my next visit (Please say why) _______________________
b) I hate the thought of my next visit
(Please say why) ________________________
18. Remembering all that you have said, how do you feel OVERALL about the Access centre? TICK (√) ONE answer you agree with. a) b) c) d) e) 19. It’s awful It’s good It’s all right It’s better than nothing It’s better than MacDonalds
Is there anything ELSE you would like to say about the centre? Please write it in the box underneath
Thank you for filling in this form. It will help us to make services better. All your answers are private. Your name will not be used anywhere. Please hand it back to a member of staff.
Appendix “D”: FOSTER CARERS’ QUESTIONNAIRE
What do YOU think about the Access Centre?
About this form … We need your point of view. It will help to make the service better Your answers are private and confidential. No name is required. There are NO “right” or “wrong” answers – it’s YOUR opinion. We want you to be as honest as you can be. If you have any problems, ask a friend or someone you trust to help you.
1. How many children do you foster? _______ Children’s ages:(write in) Boys __________ Girls _________ 2. How long have your foster children been using the access centre? Please tick (√) ONE answer Between 1 month and 3 months Between 3 months and 6 months Between 6 months and 9 months Between 9 months and one year More than one year 3. Have you ever visited the access centre? Yes I have visited the centre No I have not visited the centre I have never been invited 4. The foster children in your care usually get picked up to go to the centre. How do you feel about the pick up service? Please tick (√) as many answers that you AGREE with: I dislike it I’d rather deliver them myself I like it It saves me time My own children get upset I don’t like to wait in for it I like meeting the staff My own children like it The foster children like it I don’t have to meet the parents Anything else? (please write in) _____________________________
5).Sometimes you have to deliver or pick up children from the access centre. Tick (√) any answers that you agree with. I never delivered or picked up I don’t like running into the parents It takes a lot of time Don’t like seeing the children upset Picking up upsets my own children
6.Sometimes you have to deliver foster children for a supervised visit somewhere else (not at the access Centre)? I never delivered/picked up I delivered to social work offices 7. What was that like? Please write in __________________ 8. How do your foster children feel about the centre? Tick (√) as MANY as you like They like being at the centre They don’t like being there They find coming back upsetting They find it good fun They hate it when they leave It’s a mixture of things 9. What are the good things about the access centre service? Please write in. _______________________________________
GO TO QUESTION 8
10. What are the bad things about the access centre service? Please write in. ____________________
Can we improve the Access Centre service to make it better for YOU and your foster child? What would you CHANGE? Tick (√) AS MANY as you like. It is OK as it is Different transport arrangements Please specify _________ More frequent visits Less frequent visits More staff More contact More information Anything else
Do you feel comfortable with asking the staff questions? Tick (√) ONE answer you agree with. Yes, I always can No, I never can I sometimes can Don’t like to bother them
Sometimes staff have to cancel your visit. When it happens, how do you FEEL? Tick (√) ONE answer you agree with. It is a disappointment It is OK. It is upsetting I don’t mind
Sometimes YOU have to cancel YOUR visit. How do you get on? Tick (√) ONE answer you agree with. I feel bad about it It doesn’t matter It is necessary sometimes It can’t be avoided
Do you think staff give you enough INFORMATION? Tick (√) ONE answer you agree with. d) It is OK as it is at the minute e) They give too much information f) No, I need more information
(Please write in what kind of information you need) __________________________
Sometimes you have to get in touch with the Centre. How do you get on? Tick (√) ONE you agree with It is OK It can be hard to get in touch I don’t like leaving messages
How do YOU FEEL after your foster child’s visit to the Access Centre? Please TICK (√) as MANY as you like. Concerned Pleased Hopeful Sad Frustrated Annoyed Satisfied Anxious
18. Remembering all that you have said, how do you feel OVERALL about the Access centre? TICK (√) ONE answer you agree with. It’s awful It’s good It’s all right It’s better than nothing 19. Is there anything ELSE you would like to say about the centre? Please write it in the box underneath
Thank you for filling in this form. It will help us to make services better. All your answers are private. Your name will not be used anywhere. Please hand it back to a member of staff.
Appendix “E”: SOCIAL WORKERS QUESTIONNAIRE
Access Centre Project SOCIAL WORKERS PRELIMINARY QUESTIONNAIRE
101 INSTRUCTIONS FOR COMPLETION This questionnaire consists of almost entirely of open-ended qualitative questions. However, if you have any numerical figures or indicators that might be useful to explore at this stage could you please indicate what these are and in what form they are held – case load statistics etc. The answers will be used to help build the research project so it should be treated as preliminary exercise. I will hold the answers as confidential so [please be as forthright as you feel is appropriate If you mention individual cases as examples, please don’t use the actual names. Case A, Case B is acceptable. This is to safeguard the confidentiality of the clients, If you envisage any problem regarding what constitutes an “access case” the following will apply: " any case involving children access that requires social worker arrangements will be regarded as an access case for the purpose of this exercise. I am envisaging that multi problem families may present categorisation problems. If you need any help with answering the questions, please do not hesitate to give me a ring on any of the numbers on the cover. Leave a message and I will return your call as soon as possible Please put your reply in the envelope provided and either give it to Mary O’Loan or post it back to me at Virtual Image Research Consultants, Units 45, 14 Elgin rd Dublin 4 If you would prefer to use your co0mputer, I am happy to send the Word file for completion and return by email. We are at email@example.com The questionnaires should be returned within three weeks of receipt. If there are any difficulties, please call me!” Thank you for your help!
102 ACCESS CENTRE SOCIAL WORKERS QUESTIONNAIRE
Name _____________________ Position ___________________
How long have you worked in your current position?
What are your current arrangements for access?
For how many children do you make access arrangements? What percentage of your overall caseload does that comprise? In numbers In hours
For how many families do you make access arrangements?
103 e) On average, how many hours in your working week do access cases take? Preparation time Travel time Contact time Review time f) What percentage of your total hours worked do access cases take?
What are the best aspects of the current arrangements? I. For yourself II. For the children III. For their families
What are the worst aspects of these arrangements? I. For yourself II. For the children III. For their families
Are there any ways in which these arrangements can be improved?
In what ways would the availability of an access centre affect your work (e.g. Time management, workload, etc.)
In what ways would the availability of an access centre affect the children?
In what way would this affect the families/guardians/parents?
When the access centre is in operation are there any anticipated cost (financial) changes that you can foresee.?
When the access centre is in operation are there any anticipated resource (non-financial) changes that you can foresee.?
In an ideal world, what arrangements and resources should be in pace for child and parent access?
Is there anything else that you would like to mention (which you feel is important)?
105 Please use this space to say anything you like about the issues discussed in your questionnaire: hopes, worries, concerns or anything that you think was missed in the questions on the other pages. This is a useful space for exploring or sharing ideas about access centre arrangements, objectives, protocols and so on.
Thanks for your time!