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Greater Shepparton Vulnerability Guide Tool Kit Training Session for MCH Nurses
Insert your municipality and date
Why are we here?
“In order to achieve improved outcomes for families at risk, a paradigm shift is required, so that unequal outcomes are seen as social injustices, rather than as products of individual dysfunction or deficit.”
(Slee, 2006)
Short term Development of a shared understanding between MCH practitioners in relation to the parameters of child and family vulnerability Practitioners understand the intentof the Vulnerability Guide and feel confident to use it.
Long term Use of the Guide contributes to increased engagement of children and families who are experiencing vulnerability within our MCH services.
Training outcomes
Training content
Section 1: Introduction Section 2: Understanding Vulnerability and
Protective Factors Section 3: Using the Vulnerability GuideSection 4: Evaluation and Forward Planning
Section 1: Introduction Background information Introducing the Vulnerability Guide Value of the Vulnerability Guide Components of the Vulnerability Guide Tool Kit
Background information
In 2011 Greater Shepparton was selected as one of the two Enhanced Best Start sites in Victoria – the other was Mildura.
A key indicator was ‘to increase the access and participation rates of vulnerable children in MCH and Kinder services, particularly those children known to ChildFirst and child protection’.
Professional development Bridges out of Poverty Training Development of a Vulnerability Guide
Place based actions/ activities to increase the connection of vulnerable children and parents with MCH and kinder i. e. MCH outreach home visiting
A ‘Ready Services’ Audit
Four key activities
Background information
In 2011/12
Research was undertaken in relation to how vulnerability was defined and what already existed in relation to practice ‘tools’ The initial Vulnerability Guide
was developed and introduced.
Background information
In 2013/14
The Vulnerability Guide format was revised in response to feedback received from the Greater Shepparton MCH Team and feedback from the 2014 Vulnerability Guide Workshops
All resources related to the introduction and use of the Vulnerability Guide have been collated into this web based Tool Kit
Background information
Introducing the Vulnerability Guide
The Child and Family Vulnerability Guide has been designed, piloted and implemented with extensive input from MCH management and nurses in Greater Shepparton .
This training module has been developed so that other municipalities can utilize the set of resources developed at Greater Shepparton, to assist the introduction and use of the Vulnerability Guide within their own service
The Vulnerability Guide Elements
In developing the Vulnerability Guide, the following areas were identified as the key aspects of reflecting on the parameters and circumstances of child and family vulnerability: Child safety, stability, development and wellbeing Parent/Caregiver capability Family composition and dynamics Family circumstances and economic environment Community factors.
Protective factors
Any consideration of vulnerability factors also necessitates a reflection on the protective factors which mitigate such vulnerability.
‘Every child and family will experience some difficulties, and each will have some resources and strengths to help through difficult times’
Kids Matter - Early Childhood Information Sheet No. 6 (www.kidsmatter.edu.au)
Designed to be easy to use
Developed by
practitioners, for
Practitioners with
practitioners
The Vulnerability Guide format
Five vulnerabilitycategories
MCH Nurse considers level of vulnerability and what response is
required
Value of the Vulnerability Guide
Prompts nurses to consider a broad range of child and parent vulnerability factors, and how these may impact on child/family wellbeing
Such consideration potentially results in a greater level of responsiveness in support, counselling and referral
Child at risk icons on data base alerts other staff to vulnerability issues
‘It is really useful – you know straight away that there are factors that you need to be aware of’
Value of the Vulnerability Guide
The Guide provides a common language framework with which to discuss vulnerability issues and levels – within and across services i.e with ChildFirst
Improves data integrity Child at Risk Reports identify those children whose
needs are greatest and who should therefore be a priority for regular monitoring and support
Child at Risk Reports identify geographical concentrations of vulnerability and inform staffing decisions
‘It has been a very beneficial tool. It allows quick identification of vulnerable families. Particularly if you have not seen this family before, the teddy alert allows a quick prompt before starting the consult. It has also allowed families to have more support/follow up if they need it.’ Greater Shepparton Vulnerability Guide Evaluation November 2014
Intended Use - please note...
It is only a guide - not a risk assessment tool …
It is designed to be - an alert, a mechanism, a process, a reflection tool
The Vulnerability Guide Tool Kit
Key components – they mirror this training …Section 1 The Introduction outlines how the Vulnerability Guide Tool Kit was developed, and describes the core elements of the Vulnerability Guide and its key applications.
Section 2 Understanding Vulnerability and Protective Factors An overview of what constitutes child and family vulnerability. What does the current literature say? How does the Vulnerability Guide reflect this?
Section 3 Using the Guide in Practice Application of the Guide within Maternal & Child Health Services.
Section 4 Monitoring and Evaluation Options for monitoring and evaluating the use of the Vulnerability Guide
Section 2: Understanding Vulnerability and
Protective Factors
Family ComplexityEarly Brain Development
Cumulative HarmIntervention
Life Outcomes
Vulnerability and Protective Factors
Factors which need to be taken into account when considering vulnerability are wide ranging and often complex
It is also important to consider protective factors for children and/or their families when reflecting on potential vulnerability in child/family situations.
Vulnerability – Definitions
‘Children and young people are vulnerable if the capacity of parents and
family to effectively care, protect and provide for their long term development
and wellbeing is limited.’
Victoria’s Vulnerable Children – Our Shared Responsibility Strategy 2013-2022
Vulnerability – Definitions
It is also seen as:
“situations in which a family’s needs cannot be met from within their own resources or their kith and kinship networks and where services can make a valuable contribution to child and family well-being.”
(Arney & Scott, 2011)
Vulnerability and Protective Factors
Protective factors have been defined as "a correlate of resilience that may reflect preventive or ameliorative influences: a positive moderator of risk or adversity" (Masten & Wright, 1998).
Child or family vulnerability and its impacts can “differ enormously depending on...disposition; resilience; bio-psychological factors; family environment and other supports; peers; security; positive parent/child attachment; and previous history.”
John Briere (2002) quoted in ‘Trauma Informed Care & Practice ‘(National Trauma-Informed Care & Practice Advisory Group, Position Paper’ September 2013).
Vulnerability and Protective factors
Whiteboard/maxi sticky note activity:What comes to mind when: You think about child vulnerability You think about protective factors You consider how you respond from a practice
perspective when working with families who have identified vulnerabilities?
Who supports you in your work with vulnerable children and families?
Protective factors
Individual/child factors such as: good health positive peer relationships strong, positive social networks hobbies/interests high self-esteem independence secure attachment with parent/s social skills positive disposition.
Family/parental factors: secure attachment with child positive parent-child relationship supportive family environment extended family networks high level of parental education parental resilience concrete support for parents sound parental coping skills awareness of stages in child development.
Social/environmental factors: strong, positive social networks stable housing employment family expectations of pro-social behaviour well-resourced schools available in
neighbourhood access to health and social services.
AIFS: https://www3.aifs.gov.au/cfca/publications/risk-and-protective-factors-child-abuseand-neglect Sources: Counts, Buffington, Chang-Rios, Rasmussen, & Preacher (2010); US Department of Health andHuman Services (2011).
Read as is
Understanding Vulnerability
In understanding vulnerability there is a very broad set of parameters to consider maternal factors other parenting/family factors baby health factors parenting capability potential environmental factors combination/s of these factors.
Understanding Vulnerability
The following are criteria for funded family support services:
single risk factors that need one off, short or long term intervention. single risk factors that need an individualised response multiple risk factors and long term chronic needs high risk of long term involvement in secondary services cycles of disadvantage and poverty resulting in chronic neglect and cumulative harm
Understanding Vulnerability
Doherty, Hall & Kinder(2003) looked at vulnerable families in the following three groups:
The underrepresented: groups that are marginalised, economically disadvantaged or socially excluded
The invisible or overlooked: families who may slip through the net when service providers overlook or fail to cater for their needs.
The service-resistant: those who choose not to engage with services, including those who may feel wary about service involvement e.g. fear of children being removed.
Family Complexity
Families live under a diverse and complex set ofbackgrounds and life circumstances whichencompass a broad range of factorsincluding: Culture Language Ethnicity Education Employment Social status, interactions or appearance.
Family ComplexityAdded to these aspects are a wide range of social factors which can increase the complexity of family circumstances including:
Family break up Parent or child with intellectual/cognitive
impairment or disability Lack of parenting skills - current or intergenerational Poverty – current or intergenerational Unemployment - current or intergenerational Housing problems Drug and alcohol abuse Mental illness Family Violence.
Impacts on childrenThe potential impacts on children if these issues are present can include: Emotionally unavailable parent/s Lack of/unhealthy attachment Extreme behavioural issues Abuse and neglect Family violence and exposure to trauma Developmental delay from environment and/or
drug related birth problems Chaotic life experience.
The factors highlighted in the previous slides are reflected in the ‘indicative reasons’ of the Vulnerability Guide
Vulnerability & Early Brain Development Brain development is characterized by ‘sequential development and sensitivity’ and a capacity to organise and change in a ‘use dependent’ way.
Because brain development is sequential, disruptions to normal development in early life will necessarily alter later development of other areas of the brain.
This suggests that the early life experiences of a child have importance in the organisation of the mature brain. (Perry 1997).
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian Government Department of Human Services 2007.
Early Brain Development and Intervention
Professor Jack Shonkoff writes:“The same neuroplasticity that leaves emotional regulation, behavioral adaptation, and executive functioning skills vulnerable to early disruption by stressful environments, also enables their successful development through focused interventions during sensitive periods in their maturation.
“The early childhood field should combine cognitive and linguistic enrichment with greater attention to preventing, reducing, or mitigating the consequences of significant adversity on the developing brain.”
Shonkoff, J - Investing Early in Education (Education Forum 2011).
Vulnerability & Cumulative Harm
Cumulative harm is experienced by a child as a result of a series or pattern of harmful events and experiences that may be historical, or ongoing, with the strong possibility of the risk factors being multiple, inter-related and co-existing over critical developmental periods.
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian Government Department of Human
Services 2007.
Vulnerability & Cumulative Harm
With ongoing childhood trauma (cumulative harm), ‘chronic stress sensitises neural pathways and over-develops certain regions of the brain involved in anxiety and fear responses. Meanwhile, other neural pathways and brain regions are under-developed.’
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian
Government Department of Human Services 2007.
Vulnerability and life outcomesRecent research suggests that two out of three patients presenting at emergency, inpatient or outpatient mental health services have underlying complex trauma secondary to childhood physical or sexual abuse. If emotional abuse, chronic neglect and the impacts of witnessing domestic violence or growing up with significant family violence, substance abuse and poverty are also included, the percentage is even higher.
The single most significant predictor that an individual will end up in the mental health system is a history of childhood trauma.
*Trauma Informed Care & Practice (National Trauma-Informed Care & Practice Advisory Group, Position Paper, September 2013).
We now look at how all this theory and research impacts on our daily practice in MCH ….
Vulnerability factors and parent engagement Sample AEDC Results (insert your current AEDC results below )
Developmentally On Track 72.1%
DevelopmentallyAt Risk 16.5%(Vul on 1 or more domains)
Developmentally Vulnerable 11.4%(Vul on 2 or more domains)
Family Engaged
Child developmentally ‘on track’
Family Not
Engaged
Child‘on track’
Family Engaged
Child developmentally at risk or developmentally
vulnerable
Family Not Engaged
Child developmentally
at risk or developmentally
vulnerable
How do we define engagement?
Engagement in practice... ‘The relationship between service providers and service users is a
major factor influencing the engagement of parents in mainstream
services’
‘The service system needs to…increase its collective capacity to
respond promptly to the needs of vulnerable families by: building stronger links between services developing a systematic outreach capacity to reach isolated and
transient families providing a range of ‘soft’ entry points to the service system to suit
the needs of vulnerable families.’
CCCH Policy Brief No 18 2010: Engaging Marginalised and Vulnerable Families 2.
Vulnerability factors and parent engagement
Activity:1. Think about some of the families you work with and picture a family that fits into each of the categories:
Family engaged and child developmentally ‘on track’ Family not engaged and child developmentally ‘on track’
Family engaged and child developmentally at risk or developmentally vulnerable
Family not engaged and child developmentally at risk or developmentally vulnerable
2. Discuss how your practice is different according to the varying levels of engagement and vulnerability.
3. Record some key ideas and feed back to large group discussion.
Section 3Using the Vulnerability Guide
Getting StartedPractice Scenarios
Progressive UniversalismData Audit
Getting started – our process
Add your details here in relation to actions undertaken (actual or intended) to prepare for the introduction of the Vulnerability Guide.
Familiarise ourselves with the Vulnerability Guide Possibly up of data categories in client data base ‘alert’
fields to correspond with Vulnerability Guide ‘categories’ and ‘indicative reasons’
Preparation of materials i.e. laminate 2 sided Vulnerability Guide for each Centre• Possibly print a copy of the Vulnerability Guide Tool Kit
for each Nurse – or particular pages Undertake a data audit
Use of the Vulnerability Guide
ACTIVITY: MCH Scenarios - working in pairs or small groups:With reference to the Vulnerability Guide and using the Practice Scenarios What do you think are the key indicative reasons and the subsequent primary vulnerability category for this child/children What level of vulnerability would you think is
appropriate to denote in the client record? Feedback to larger group
Activity
Familiarize Nurses with the relevant sections of the Vulnerability Guide Tool Kit - how the level of vulnerability and indicative reasons are recorded in the MCH client data system.
Progressive Universalism and the Vulnerability Guide
MCH – working across the spectrum of vulnerability
How do you think the use of the Vulnerability Guide would assist us to identify and document the vulnerability and protective factors which influence this continuum? In what ways would it be useful when a MCH Nurse is working collaboratively with other services to provide ‘integrated support’ for a child and their family experiencing vulnerability?
MCH – working across the spectrum of vulnerability
ActivityLet’s think for a moment about how our MCH Service works across this continuum of vulnerability. Our schedule of visits Provision of outreach and additional visits/contact How we use our Enhanced MCH resources How we work with other agencies to provide
integrated support to families
Now for the …… Data Audit
This is a great way to improve data accuracy
Customise your own words from here re your process We will be undertaking a
data audit and have prepared a guide for this
Now for the …… Data Audit
We will use our Child At Risk Reports to assist us to see which children require a review of vulnerability risk/status
Determining the vulnerability status of children on our system with an ‘alert’ designated, whom we have not been able to contact for more than 2 years. We will be liaising with ### (ChildFirst) agency to develop an interagency protocol to assist with this.
Now for the …… Data Audit
Activity
Walk through data audit process Consider any priorities
Consider Child at Risk/other system reports which denote alert listings.
Section 4 Evaluation and Forward Planning
Evaluation methods The Next Steps
Monitoring and Evaluation
Examples The evaluation feedback from Vulnerability Guide workshop sessions Xpedite/MaCHS Children At Risk Reports - used to monitor progress of data audit Other data reports that list types of vulnerability identified Practitioner surveys such as Survey Monkey to evaluate effectiveness of the Vulnerability Guide. Reflection at Team Meetings
Monitoring and Evaluation
Xpedite/MaCHs Children At Risk Reports - used to prioritise family contact/follow up and monitor progress of data audit Insert sample data.
Baker St Truror Capital Ave Levesely Dartly Cres Wanganelli0
10
20
30
40
50
60
70
No. of children currently at risk August 2014
No. currently at Risk
Monitoring & Evaluation
Monitoring and Evaluation
Suggested Activity: Xpedite/MaCHsNurses to look at their individual centre Children At Risk Reports. Raise and discuss any issues in relation to Data Audit. Team Leader to prepare contrasting examples of levels of vulnerability per centre – discuss.
The Next Steps….
Add your steps here Development of an implementation plan with
timelines and designated responsibilities. Implement and use the Vulnerability Guide
Tool Kit within our team Ensuring that the Vulnerability Guide is used
consistently as part of ongoing individual and team practice with children and families by …….(add actions)
