Community services of the future - An evidence review January 2018
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Community services of the future
An evidence review
January 2018
About the Future Social Service Institute
The Future Social Service Institute (FSSI) is a
collaboration between the Victorian Council of
Social Service and RMIT University, funded by
the Victorian Government.
FSSI supports the social service workforce to be Authorised by
service-delivery leaders at a time of major growth David Hayward
and disruption. We: FSSI Director
CO-DESIGN world-best workforce Edited by
education programs Paul Ramcharan
HELP TRAIN the workforce of the future and Sally Thompson
RESEARCH emerging trends and
opportunities, and © Copyright 2018
EMPOWER not-for-profit organisations to
Future Social Service Institute
reorient to a global market.
e info@futuresocial.org
p (03) 9925 4619
w www.futuresocial.org
t @FutureSocialAU
f /FutureSocialAU
Page | 2 Community services of the future: An evidence review
Contents Executive summary ................................................................................................................ 5 Key findings ........................................................................................................................... 5 Introduction ........................................................................................................................... 7 CHAPTER ONE Flexible person-centred funding models ........................................................ 10 CHAPTER TWO Place-based services and systems ................................................................ 17 CHAPTER THREE Person-centred services............................................................................ 24 CHAPTER FOUR Workforce of the future for Community Services Industry Plan ...................... 32 CHAPTER FIVE Strengthening outcomes ............................................................................... 41 CHAPTER SIX Information sharing and technological innovation ............................................. 47 CHAPTER SEVEN Regulatory frameworks .............................................................................. 53 CHAPTER EIGHT Governance and leadership ....................................................................... 60 CHAPTER NINE Organisational and industry readiness .......................................................... 67 CHAPTER TEN Embedding evidence .................................................................................... 74 CONCLUSIONS .................................................................................................................... 80 Weighing the evidence for the community services of the future. ............................................ 80 Getting research clever - Vehicles for community sector research in the future ........................ 93 Creating the right conditions for community sector research in the future ................................ 97 Page | 3 Community services of the future: An evidence review
Executive summary
The Future Social Service Institute (FSSI) was commissioned by the Community Service Industry
Plan Working Group to write evidence reviews in 10 areas identified by the community sector as
priorities. The reviews would be designed to inform the Industry Plan and to gauge the future
research needs of the community sector.
Key findings
The community sector is facing unparalleled changes inter alia:
demand driven, individualised and marketised systems, new
regulatory environments, transformations in management practice
and leadership.
Based on these 10 evidence reviews, the community sector can be
characterised as being 'research poor'.
Reviews of 'person-centred services' and 'place-based services and
systems' showed little evidence and transferability of findings, were
hampered by context and jurisdictional differences, and short-term
research unable to sufficiently address complexity and causation.
Consistent evidence has emerged around flexible person-centred
funding. Better outcomes are produced with sufficient funding
where information and support for decisions is available and where
there are services and workers to convert funding into outcomes.
In all reviews linked to outcomes for service users, more research is
required for hard-to-reach groups and those who have not benefited
from new policy and practice.
Four of the 10 reviews explored sector processes: strengthening
outcomes, regulatory frameworks, governance and leadership and
organisational and industry readiness. The volume of research in
these areas was found to be particularly low. Regulatory
frameworks can change the governance, leadership and outcomes
adopted in the sector. There is a chance that some approaches may
undermine the sector’s mission. Research in all four areas is
required along with research on the impact of new regulatory
systems on the operation of the sector itself.
Page | 5 Community services of the future: An evidence review Two reviews explored future innovation: information-sharing and
technological innovation, and embedding evidence. The speed of
technological change applies widely across the sector, but there is
little research around the impacts of such change. More research is
needed on the relevance, efficacy and ethics of using Big Data,
predictive analytics and combining datasets. Good practice in co-
design has the potential to drive sector change based on the
continuous flow of information on experiences and outcomes from
those who use sector services and supports. There remain huge
questions around sharing data, shared platforms and the
interoperability of new IT and database systems, which require
research attention.
The future workforce will transform out of all recognition, especially
short-term in the disability sector and longer term in the ageing
sector. More systematic data collection might be supported by
worker registration for the sector and by better access to
administrative datasets. Given the level of change, longitudinal
research is essential in this area, and in the associated area relating
to workforce training.
Wider conditions to support research in the sector suggest the need
for: substantially greater research funding; more support to
community sector organisations which would struggle to fund
research themselves; and clarity on sector outcomes emerging from
co-designed research that could drive regulation and sustainable
service change based on best practice.
Importantly, a way of organising 'dedicated research support' to the
sector, but independent of any single sector interest, is required.
Such an arrangement would establish sector-generated research
priorities. It would search for and bring funding together for
industry-relevant collaborative research, and it would act as a
support at the level of co-design and production for the wider
dissemination.
A guiding principle of research must always be to explore the extent
to which the values and mission of the community sector are
conserved by any new policy, strategy or practice.
Page | 6 Community services of the future: An evidence reviewaged care services6. The Productivity
Introduction Commission estimates the need for 70,000
additional disability support care workers as
Background the NDIS rolls out up to 2019-
1 in 5 of all new jobs created in Australia in
The community sector in Victoria, and more
.7
widely in Australia, is going through and is
prospectively subject to, significant and Yet a growing proportion of that workforce is
ongoing change. precariously employed and lower paid and,
it may be added, is gendered, with four out
The community sector is crucially important.
of every five of its employees (80%) being
Registered charities alone contribute more
women. The growing workforce alone
than $13 billion a year to the economy1, and
represents a significant challenge to the
the sector as a whole, therefore,
industry as well as to training and career
considerably more. But independent of the
pathways, as further detailed by Kyle,
economic contribution, the sector
MacDonald and Bentham in this volume.
strengthens the fabric of Victorian
communities, finds pathways to overcome
poverty and promote active citizenship, acts
Yet a growing proportion
as a compass for policy change and
of that workforce is
advocacy based on its on-the-ground
precariously employed
engagement, supports significant levels of
and lower paid and, it
volunteering and is itself a major employer in
may be added, is
Victoria.2
gendered, with four out of
In A Growing Industry3 the Victorian Council every five of its employees
of Social Service (VCOSS) states the (80%) being women.
Victorian community sector employs 150,
000 people, more than any other key
industry in the economy. Due to population As the public sector withdraws from direct
growth, an ageing population and the service provision, the choice of service by
introduction of the NDIS, the sector will consumers, many using individualised
likely grow by 16 per cent between 2015 funding8, now places the sector in a
and 20204, accounting for almost a quarter competitive market9 as block funding is
of all projected employment growth to that withdrawn. Whilst expenditure around
year5. The aged care workforce alone will individualised funding, particularly in
need to expand from 366,000 to 980,000 by disability have risen, sector organisations are
2050 to meet the needs of increasing faced with multiple accountabilities and
numbers of older Australians accessing outcomes-based funding in new regulatory
1 6
VCOSS (2015) Building on the value of Victoria's community Committee TSCAR (2017) Future of Australia's aged care
sector, VCOSS: Melbourne. sector workforce , Commonwealth of Australia: Canberra.
2ibid. 7 Productivity Commission (2017) National Disability
3VCOSS (2017) Insurance Scheme (NDIS) Costs. Productivity Commission
community sector charities, VCOSS: Melbourne, p.22. Study Report: Overview, Commonwealth of Australia:
3 ibid., p.22 Canberra.
4ibid., p.22 8Dickinson H. & Glasby J. (2010) The personalisation
5
Department of Employment 2017.Regional agenda: Implications for the Third Sector , Third Sector
Projections to November 2020. Available from Research Centre: Birmingham.
9
http://lmip.gov.au/default.aspx?LMIP/GainInsights/Em Davidson, B. (2009) For-profit organisations in managed
markets for human services , Ch. 3 in King, D. & Meagher,
ploymentProjections.
G. (eds) Paid Care in Australia: Politics, Profits, Practices,
Sydney University Press: Sydney, pp.43-79;environments (see Andrews, this volume), The work in each review presents evidence
the community sector will need careful in 10 chapters, one contributed by each
thought, leadership and governance as author, drawing upon their own academic
Dickinson (this volume) attests. New skills expertise. The reviews are therefore
may be needed to address these complex independent of other interests.
changes when, as has been asserted, the
sector has previously struggled with such
change management.10 In reading the following
reviews the reader will
Major, and once-in-a-generation policy shifts
very soon become aware
to marketised and personalised services,
of the massive job facing
demographic change and workforce
the community sector in
demands represent a real threat to the
the next decade, the
mission and values of the community sector.
huge shift in culture
Evidence in relation to personalisation are
required, and the need
addressed by Laragy in this volume, as is
for much more evidence
the emergence of place-based approaches,
to inform the sector
by Cordoba.
through this period of
The changes outlined above represent a 'multi-paradigmatic shift'.
'multiple paradigm shift' of immense
challenge. They also take place at a time in
which the rate of change in technology and The evidence review was commissioned by
its application in the community sector are VCOSS and managed by the Future Social
growing, as outlined by Karanasios (this Service Institute (FSSI), a collaborative body
volume) and where new forms of evidence funded by the Victorian State Government
production are emerging (see Ramcharan, and RMIT University, and operating in
this volume). collaboration with VCOSS. The brief was to
find academic experts who would undertake
The melange of changes outlined will
a high level environmental scan and analysis
require huge investment for change
of evidence to support the Victorian
management itself, and longer term as the
Community Services Industry Plan, which is
community sector seeks transformation One
presently in development. Each evidence
way of seeking to address the above issues
review was peer-reviewed by FSSI and
is to explore what evidence exists that has
edited to meet the brief, but without
the capacity to drive change in the sector.
changing the arguments and conclusions
This volume, in small measure, seeks to
drawn by each of the authors.
fulfil this role.
FSSI was asked to undertake these evidence
Scope of this review
reviews in 10 key areas by the Community
This volume is made up of 10 evidence Services Industry Plan Working Group. This
reviews, which seek to address key issues group identified 10 key priority areas in
for the community sector as it develops a consultation with the community sector,
Community Services Industry Plan for the where further evidence might inform the
coming decade. continuing development of the Industry
Plan.
10Butcher, J. The third sector and government in Australian Journal of Political Sciences , Vol. 50, No. 1, pp.
Australia: Not-for-profit reform under Labor, 2007-13 148-163.
Page | 8 Community services of the future: An evidence reviewConsequently, the 10 evidence reviews
presented in this volume have been In reading the following
undertaken to reflect these 10 identified reviews the reader will
priority areas. very soon become aware
of the massive job facing
After presentation of the 10 evidence the community sector in
reviews, a final chapter seeks to distil key the next decade, the
messages to inform the Industry Plan and, huge shift in culture
further, to gauge the future research needs required, and the need
of the sector. In reading the following for much more evidence
reviews the reader will very soon become to inform the sector
aware of the massive job facing the through this period of
community sector in the next decade, the 'multi-paradigmatic shift'.
huge shift in culture required, and the need
for much more evidence to inform the sector
through this period of 'multi-paradigmatic
shift'.
Page | 9 Community services of the future: An evidence reviewof Health and Human Services has a
CHAPTER ONE procurement policy that purchases goods
and services using tenders and grants to
Flexible person-centred provide person-centred services in the fields
funding models of health, disability, ageing, mental health,
families, children, youth and family
Dr Carmel Laragy violence12. While acknowledging that block
funding continues to be used to purchase
Senior Research Fellow, Centre for Applied services in these areas, this chapter focuses
Social Research, RMIT University on flexible person-centred funding models
using individual funding.
Introduction
Differences between individual funding
The introduction of person-centred programs nationally and internationally in
individual funding models has been driven different sectors tend to make direct
by advocates wanting greater choice and comparisons difficult. However, taken
control; and by governments with policies of collectively evaluations point to a surprising
human rights and economic imperatives. uniformity about success factors and both
Governments believe that a competitive large scale randomised studies and small in-
marketplace will deliver more responsive depth case studies regularly come to similar
and accountable services11. This chapter conclusions. People need adequate funding,
reviews national and international literature information and support to make informed
on person-centred individual funding decisions, and appropriate services to
models and identifies factors that contribute purchase. These factors are shown in Figure
to their success. The Victorian Department 1.
Figure 1: Key factors determining outcomes in person-centred individual funding models
Funding level
Information Availability
& support services &
provided workers
11ProductivityCommission. (2017). Shifting the Dial: 5 Year 12
Productivity Review. Canberra: https://dhhs.vic.gov.au/funding-grants-and-tenders-0 , (last
https://www.pc.gov.au/inquiries/completed/productivity- accessed 19th Jan, 2018).
review/report/productivity-review.pdf, Last accessed 18 th
Jan 2018.
Page | 10 Community services of the future: An evidence reviewCase Study
A widow aged 83 had a Consumer Directed Care aged care package. She regularly
attended her local church services and functions until her mobility decreased. Church
members provided her with car transport until the point when she needed more support
than they could provide. She was distressed at the prospect of being unable to atten d
church and losing her social network. She spoke to her service provider about changing
her support arrangements and having a support worker accompany her to church
services and functions. When her provider was unable to provide staff at the necessary
times she rang a few others and found one who could assist if she was willing to pay
penalty rates and reduce her hours of support. She accepted these conditions, changed
her provider, and continued her social participation and maintained her social network .
The aged care case study above Scheme (NDIS) is considered well-funded
demonstrates how individual funding can through the initial Medicare levy of 0.5%
give people more choice and control if and a further 0.5% levy to be imposed in
service providers are flexible and responsive 201916.
to their needs. In this example an aged care
provider held and managed the older
funds and 'the person' has some choice as
isted with planning
to where supports are purchased. When
and payments. The guidelines required that
ref
the funds be spent with a registered service
family member or representative may be
provider. As funding is a key determinant of
assisting them. This does not deny that
outcomes, discretion is needed when
family members may have separate needs
comparing research findings across
and that their views may differ. Some
programs and across countries. The United
Kingdom (UK) austerity measures have had
and funds can be spent with few
a devastating impact on programs and the
restrictions, these exist in some European
outcomes they achieve13. Individual budgets
countries including Germany17 and Sweden.
have been reduced, and staff have been
Australia has followed the UK and the US in
pressured to make decisions for people
requiring that spending be restricted to a
instead of building a relationship and
tightly defined plan. Key features across four
assisting the person make their own
key dimensions are shown in Figure 2. The
decisions14. Critics argue that cost cutting
research studies discussed below often do
measures
not describe the program design and what
rights, and principles of choice and control
dimensions exist, which makes comparisons
have been discarded15. In comparison to the
difficult.
13Larkin, M. & Mitchell, W. (2015) Carers, Choice and Practitioners? British Journal of Social Work, 46: 3, pp.
Personalisation: What Do We Know? Social Policy & 719-736.
Society, First View Articles, pp.1-17. 16Productivity Commission.(2017). National Disability
14Lymbery, M. (2014) Social Work and Personalisation: Insurance Scheme (NDIS) Costs: Study Report . Canberra:
Fracturing the Bureau-Professional Compact? British http://www.pc.gov.au/inquiries/completed/ndis-
Journal of Social Work , 44, pp.795 811. costs/report/ndis-costs-overview.pdf, (last accessed 18th
15Hamilton, S., Tew, J., Szymczynska, P., Clewett, N., Jan 2018)
Manthorpe, J., Larsen, J. & Pinfold, V. (2016) Power, 17
Alakeson, V. (2010) International development in self-
Choice and Control: How Do Personal Budgets Affect the directed care , Issue Brief, The Commonwealth Fund, 78,
Experiences of People with Mental Health Problems and
pp.1-11.
Their Relationships with Social Workers and Other
Page | 11 Community services of the future: An evidence reviewFigure 2: Key dimensions of individual funding models Importance for community service organisations
How funds are Where funds can be
Who holds the funds:
managed: Assistance provided: spent:
Person or service
Self-manage / Little or none Open market or
provider
professionally managed registered services
The introduction of person-centred evaluations showed that it was quite
individual funding models is changing every successfuli.When the program expanded to
aspect of community service organisations' the capital Perth, a small number of service
service model. Ethics and values are providers used the flexible funding creatively
challenged in a fee-for-service market to facilitate community living arrangements
economy where the most vulnerable can be for people with disability18. Notably most
overlooked; financial systems have to be
reconfigured to manage individual and continued to function as they had under
payments; and workforce recruitment is block funding. Most people did not know
precarious with financial resources being they had individual funding. This example
shows that simply allocating people an
Major cultural and organisational changes individual budget does not necessarily bring
are required to navigate this new landscape. about change.
Factors that need to be addressed are
Victoria commenced the Futures for Young
outlined below. Some factors, such as
Adults program in 1996 and allocated an
allocated funding, are beyond an
individual budget for students with disability
transitioning from school19. The Support &
proactively managed drawing on evidence
Choice program followed in 2003. Like
outlined below about maximising outcomes
evaluations of many individual funding
in the sector.
programs, an evaluation was conducted the
National trends following year when the program was in its
infancy and findings showed upheaval and
Australia has a long history of individual uncertainty20. Despite this limitation, the
funding in the disability sector. The Western evaluation identified key factors needed for
Australian Local Area Coordination program success that are reported in nearly every
commenced in 1988 for people living in individual funding assessment. These are
rural and remote areas where there were no adequate funding, user friendly processes
services. A network of supports was and practices, skilled facilitators, support to
organised for the person that employed make decisions and access services and
family and community members
18Forsyth,L., Doyle, N., & Zubrik, R. (2016). Consumer 19Laragy, C. (2004) Self-determination within Australian
Directed Care reforms: Navigating the competitive aged school transition programmes for students with a disability
care landscape . Australia: Disability & Society, 19: 5, pp.519-530
20
https://home.kpmg.com/au/en/home/insights/2016/08/cons LIME Management Group (2005) Evaluation of Support &
umer-directed-care-reform-war-for-care-talent.html (last Choice Implementation: A report for the Victorian
accessed 18th Jan 2018) Department of Human Services
Page | 12 Community services of the future: An evidence reviewsupports, available services to purchase, turnover, more unfunded work, and
and a welcoming and inclusive community. more casual and less well-paid work
Two major evaluations of the early stages of There is a severe workforce shortage
and it is estimated that 1 in 5 new
processes and outcomes. These studies jobs over the next few years will
were conducted by the Productivity need to be in disability support to
Commission21, and the National Institute of meet demand
Labour Studies (NILS) at Flinders University, ere
there are insufficient support
evaluation22. Findings from the two studies services and no competition the
Productivity Commission
are similar and some aspects reflect findings
encouraged the NDIS to consider all
from an aged care Consumer Directed Care
options to overcome this shortage,
evaluation23:
including block-funding and skilled
Many (but not all) NDIS participants migration.
received more disability supports While the majority of NDIS
than previously, had more choice participants did not change
and control over the supports they providers, their confidence grew over
received, had improvements in their time
quality of care, greater Service providers had to change
independence and an increase in their business models; there was
overall wellbeing. increased merger and acquisition
People who missed out included: activity; entry of new providers; exits
those with psychosocial disability; from the sector; and more guarded
complex and multiple disabilities; relationships between providers
language and cultural barriers; When group-based services ceased
transitioning into the community because of funding changes, some
from the criminal justice system; the participants lost the opportunity to
homeless; and the socially isolated. mixed socially
Some non-NDIS participants
Poor quality of staff and NDIS received fewer services while others
workforce pricing constraints are
negative factors received no supports at all
Planners need specialised training to Support for carers (within and
engage in pre-planning and planning outside of the NDIS) diminished with
conversations and produce quality the introduction of the NDIS.
plans
The workforce had decreased
opportunities for training, increased
disability-insurance-scheme/ndis-evaluation-intermediate-
21Productivity Commission.(2017). National Disability report (Last accessed 18th Jan 2018)
23Department of Social Services. (2015). Formative
Insurance Scheme (NDIS) Costs: Study Report . Canberra:
http://www.pc.gov.au/inquiries/completed/ndis- evaluation of the Home Care Packages Programme:
costs/report/ndis-costs-overview.pdf (last accessed 18th Detailed findings report.
Jan, 2018) https://agedcare.health.gov.au/sites/g/files/net1426/f/docu
22Mavromaras, K., Moskos, M., & Mahuteau, S. ments/09_2015/formative-evaluation-of-the-home-care-
(2016).Evaluation of the NDIS, Intermediate Report . packages-programme-detailed-findings-report.pdf (Last
National Institute of Labour Studies (NILS), Flinders accessed 18th Jan 2018)
University. https://www.dss.gov.au/disability-and-
carers/programs-services/for-people-with-disability/national-
Page | 13 Community services of the future: An evidence reviewMajor national and international Support
trends Across all sectors the provision of support
Professor Beresford from the Centre for was a key success factor in individual
Citizen Participation at Brunel University, funding programs. The UK offered everyone
London classified findings from his studies receiving disability support Direct Payments,
on individual funding programs under eight which is a self-managed model that requires
headings24. These headings will be used people to manage with no assistance.
below to present a summary of the literature People could pay for coordination support
reviewed and to point to best sector practice from their allocated budget, as occurs in
given the evidence reviewed above. Australian aged care Consumer Directed
Care programs. UK evaluations found that
Funding vulnerable people, e.g. the aged29 and those
with mental illness30 struggled to self-
Welfare spending cuts in the UK25 and the
manage and did not record positive
USA26 have severely reduced service
outcomes.
provision. Australia is in the 'fortunate'
position of having NDIS disability support In contrast, the United States (US) Cash and
funding increased with the Medicare levy. Counseling program conducted in 15 states
Other areas of social services such as demonstrated the benefits of providing
health, education and aged care struggle to planning and administrative assistance. All
provide services within their allocated people self-directed their supports and
budgets. Despite this injection of funds into managed their services, including vulnerable
disability services, not everyone needing aged31and others with mental health
support has all their needs met27. There are issues32. The extensive randomised
also grave concerns for people with disability controlled evaluations using qualitative and
deemed ineligible for the NDIS because quantitative measures found that most
previously available state-based services are people achieved positive outcomes. The
closing28. Yet adequate funding and significant difference between the UK and
coverage are key components that produce US models was the unlimited planning and
best outcomes. administrative assistance provided in the US
to the person being supported at no
additional cost to them. The support staff
24 29
Beresford, P., Fleming, J., Glynn, M., Bewley, C., Croft, Moran, N., Glendinning, C., Wilberforce, M., Stevens, M.,
S., Branfielde, F. & Postle, K. (2011) Supporting People: Netten, A., Jones, K., Jacobs, S. (2013) Older people's
Towards a person-centred approach, The Policy Press: experiences of cash-for-care schemes: evidence from the
Bristol. English Individual Budget pilot projects Ageing and
25
Department of Social Services. (2015). Formative Society, 33: 5, pp.826-851.
30
evaluation of the Home Care Packages Programme: Hamilton, S., Tew, J., Szymczynska, P., Clewett, N.,
Detailed findings report. Manthorpe, J., Larsen, J., & Pinfold, V. (2016) Power,
https://agedcare.health.gov.au/sites/g/files/net1426/f/docu Choice and Control: How Do Personal Budgets Affect the
ments/09_2015/formative-evaluation-of-the-home-care- Experiences of People with Mental Health Problems and
packages-programme-detailed-findings-report.pdf, (last Their Relationships with Social Workers and Other
accessed 18th Jan 2018) Practitioners? British Journal of Social Work , 46: 3,
26USAhttp://money.cnn.com/2012/08/09/news/economy/we pp.719-736.
lfare-reform/index.htm (last accessed 18th Jan 2018) 31San Antonio, P., Simon-Rusinowitz, L., Loughlin, D.,
27Warr, D., Dickinson, H., Olney, S., Hargrave, J., Eckert, J. K., Mahoney, K. J., & Ruben, K. A. D. (2010)
Karanikolas, A., Kasidis, V., Wheeler, J. (2017). Choice, Lessons from the Arkansas cash and counseling program:
control and the How the experiences of diverse older consumers and their
NDIS.http://socialequity.unimelb.edu.au/news/news- caregivers address family policy concerns Journal of Aging
archive/choice-control-and-the-ndis-report, (last accessed and Social Policy, 22: 1, pp.1-17.
18th Jan 2018) 32
Barczyk, A. N., & Lincove, J. A. (2010) Cash and
28
LIME Management Group (2005). Evaluation of Support & counseling: A model for self-directed care programs to
Choice Implementation: A report for the Victorian empower individuals with serious mental illnesses Social
Department of Human Services. Work in Mental Health, 8: 3, pp.209-224.
Page | 14 Community services of the future: An evidence reviewproviding personal assistance worked to Informal care
establish a positive relationship with the
person. Sector outcomes are likely to be A literature review conducted in 2015
better where such support is provided. examined the impact of individual funding
on carers of people with mental illness. This
Workforce
for carers when the person receiving support
Two recent NDIS workforce reports raised
spent less time in psychiatric hospitals and
concerns that have implications across all
criminal justice settings, gained employment
social service sectors. The Productivity
and had a better quality of life36. However,
Commission reported workforce shortages33,
carers became stressed and burdened when
and a joint university-union study found that
no appropriate support was available to
pay rates for support workers were too low to
assist with managing support services and
attract and retain a suitably skilled
these tasks fell to family carers. The
workforce34.
Productivity Commission also reported
positive outcomes for some carers
participating in the NDIS, although little data
Casualisation of the
were available, and they recommended
workforce and split shifts
more data be routinely collected4. As some
were increasing and
marginalised NDIS participants did not gain
workers were not paid for
any benefits from the NDIS, it follows that
travel time.
their carers probably did not as well. Flexible
individualised funding models need to
This report identified a wide range of consider their effects on with family
workforce concerns including low pay rates, caregivers and maximise their benefits.
not allowing time for mandatory training, Institutionalisation
building relationships with participants,
communicating with supervisors and other Beresford found in his individual funding
workers, or the completion of paperwork. studies in the disability (including mental
Casualisation of the workforce and split health) and aged care sectors that some
shifts were increasing and workers were not organisations continued to expect people to
paid for travel time. Similar issues were fit into their regime. The organisations were
identified in the UK35. A major exploration of
workforce changes is required as a result of needs. Similarly, an Australian aged care
the introduction of flexible funding and study of Consumer Directed Care found that
marketised services (see MacDonald, this change management was challenging when
volume). all systems, processes and attitudes had to
change radically37. Strong sector leadership
33Hamilton, S., Tew, J., Szymczynska, P., Clewett, N., 35Hussein, S. & Manthorpe, J. (2012) Structural
Manthorpe, J., Larsen, J. & Pinfold, V. (2016) Power, marginalisation among the long-term care workforce in
Choice and Control: How Do Personal Budgets Affect the England: evidence from mixed-effect models of national
Experiences of People with Mental Health Problems and pay data Ageing and Society, 34: 1, pp.21-41.
Their Relationships with Social Workers and Other 36You, E., Dunt, D. & Doyle, C. (2017) How would case
Practitioners? British Journal of Social Work , 46:3, -directed care
pp.719-736. environment in Australia? Health and Social Care in the
34Cortis, N., Macdonald, F., Davidson, B. & Bentham, E. Community, 25: 1, pp.255 265.
(2017) Reasonable, necessary and valued: Pricing 37Laragy, C. & Allen, J. (2015) Community aged care case
disability services for quality support and decent jobs , managers transitioning to consumer directed care: more
SPRC, Sydney.: than procedural change required Australian Social Work,
https://www.sprc.unsw.edu.au/media/SPRCFile/NDIS_Prici 68: 2, pp.212 227.
ng_Report.pdf (last accessed 18th Jan 2018)
Page | 15 Community services of the future: An evidence reviewand peer support were effective in assisting people were accessing more mainstream
with change management (see Dickinson, services, improvement is needed if inclusion
this volume). is to be achieved.
Organisational structures The transition to a market-led service system
is blurring the distinction between specialist
Beresford found that organisational and mainstream services. Specialist service
structures can be overly bureaucratic, providers are required to compete in an
dominated by managerialism and open market and their viability is precarious
preoccupation with negative risk which if they cannot adapt. There are also
concerns a market service system is leaving
Similar observations have been made of the vulnerable people without support if they
NDIS38. Models achieving dignity of risk cannot navigate the service system.
tend to produce better outcomes as
Person-centred individual funding models
evaluated by those using services.
have been widely promoted as increasing
Occupational practice
assumption that people can purchase
Numerous Australian and international services and supports from a wide selection
studies reported that professional staff often in the marketplace. However, there are
found it difficult to adapt to new ways of intrinsic tensions in a market economy
working which required them to share power where no one is responsible for protecting
with people using the service39. the rights of vulnerable people. Disability
Professionals had to unlearn old practices of advocates who lobbied for the introduction
having authority to make decisions about of individual funding envisaged collective
peer support40. However, this ideal has not
facilitate and empower others. Many been realised, especially where: there are
professionals found this change threatening budget cuts; no support is provided; and
and challenging. As with institutional there are no appropriate services to
change, strong leadership, training and peer purchase. Interestingly the Productivity
support contributed to effective change Commission recently suggested that block
management strategies. funding be reconsidered in areas where
and necessary
Access to mainstream services
services have not emerged in the market.41
The Productivity Commission4 identified that
the interface between NDIS disability and
mainstream services is poorly defined and
better coordination is needed between
different levels of government. While some
38USA: 40Mladenov, T., Owens, J. & Cribb, A. (2015)
http://money.cnn.com/2012/08/09/news/economy/welfare- Personalisation in disability services and healthcare: A
reform/index.htm (Last accessed 18th Jan, 2018) Warr, D., critical comparative analysis Critical Social Policy, 35: 3,
Dickinson, H., Olney, S., Hargrave, J., Karanikolas, A., pp.307 326.
Kasidis, V., Wheeler, J. (2017) Choice, control and the 41Hamilton, S., Tew, J., Szymczynska, P., Clewett, N.,
NDIS: http://socialequity.unimelb.edu.au/news/news- Manthorpe, J., Larsen, J. & Pinfold, V. (2016) Power,
archive/choice-control-and-the-ndis-report (Last accessed Choice and Control: How Do Personal Budgets Affect the
18th Jan, 2018)
39You, E., Dunt, D. & Doyle, C. (2017) How would case
Experiences of People with Mental Health Problems and
-directed care Their Relationships with Social Workers and Other
environment in Australia? Health and Social Care in the Practitioners? British Journal of Social Work , 46: 3,
Community, 25: 1,pp.255 265 pp.719-736.
Page | 16 Community services of the future: An evidence reviewdriven by the central idea that for the
CHAPTER TWO provision of effective services stakeholders
Place-based services and process to address the issues as they are
systems experienced within a geographical space, be
it a neighbourhood, a region or an
42
Dr Pushkar Sebastian Cordoba .
Lecturer, Social Work, GUSS, RMIT Place-based services and systems have
University been the focus of significant attention over
the past few years at a policy, research and
community level43 44 45 46. This interest is
Introduction driven by the central idea that the complex
psychological, health and social issues that
An overview of the key literature and people experience require government and
evidence for place-based services and community sector services that concentrate
systems requires consideration of the main on the social and physical environments,
understandings and debates in this working collaboratively with all key
emergent area, highlighting the evidence stakeholders. There is significant evidence
base for these approaches and case studies to demonstrate the relationship between
exemplifying what such approaches look like
when operationalised. These are provided including for example the extensive work on
below and consequent to these a series of the Social Determinants of Health47 48.
points relevant to the community sector are Research has conclusively shown that
presented as topics for future discussion. people living in disadvantaged areas have
poorer outcomes in key indicators including
Literature on place-based services
health, education, employment and general
and systems wellbeing49 50 51. This is not to say that these
Defining what constitutes place-based issues are limited to people living in certain
services can be challenging given the areas, one of the limitations of this approach
absence of a universally agreed upon but, rather, that services need to take into
definition. Despite this, there are some consideration the significant influence that
common characteristics to all approaches, place and context has on health and
wellbeing. In addition to individual
42
Bellefontaine, T. & Wisener, R. (2011) The Evaluation of 47
Commission on the Social Determinants of Health (2008)
Place-Based Approaches: Questions for Further Research : Closing the Gap in a Generation: Health Equity through
Policy Horizons, Canada. Action on the Social Determinants of Health , World Health
Organisation: Geneva, Switzerland
43 48
Moore, T.G. & Fry, R. (2011) Place-based approaches to Hughes, P., Black, A., Kaldor, P., Bellamy, J. & Castle, K.
child and family services: A literature review , Murdoch (2007) Building Stronger Communities, University of New
South Wales Press: Sydney, NSW.
Hospital Centre for Community Child Health: Parkville, 49
Australian Institute of Health and Welfare (1999) The
Victoria Burden of Disease and Injury in Australia , AIHW cat. No.
44
Smyth, P. (2008) Place based policy at the crossroads: PHE 17.
A summary report of the social inclusion and place based 50
Edwards, B. & Bromfield, L.M. (2009) Neighborhood
disadvantage workshop, Brotherhood of St Laurence: -
Fitzroy, Victoria. social behavior: Evidence from an Australian national
45
Ibid sample Children and Youth Services Review , 31: 3,
46
Wilks, S., Lahausse, J. & Edwards, B. pp.317-324.
(2015) Commonwealth place-based service delivery 51
Baum, S. (2008) Suburban Scars: Australian Cities and
initiatives: Key learnings project, Australian Institute of Socio-economic Deprivation, Urban Research Program
Family Studies: ACT Research Paper 15, Urban Research Program, Griffith
University: Brisbane, Queensland.
Page | 17 Community services of the future: An evidence reviewapproaches, place-based approaches Government and community sector
provide a strategy to address issues like services specifically designed to
disadvantage and health inequality by meet the needs of communities,
developing services and systems that are groups, locations of communities
designed to collaboratively meet the specific and all relevant stakeholders being
needs of a particular location52 53. engaged to foster collaborative
decision making.
A partnership-based approach
Place-based approaches between all stakeholders including
provide a strategy to the community sector and the
address issues like broader community, between service
disadvantage and health providers, and between
inequality by developing communities, community sector and
services and systems that government.
are designed to A particular emphasis on developing
collaboratively meet the local skills and capacity building
specific needs of a The ability of services and systems
particular location. to adapt to new learnings
Stakeholder interests being seen as one
Place-based approaches have been aspect of a larger framework for service
developed both locally and internationally to delivery that also encompasses individual
address a varied range of policy issues and broader policy work programs that
including health54, housing55, mental require time and adequate funding and
resourcing focusing on long-term outcomes.
health56, social inclusion57, family wellbeing58
and sustainability59. Despite this great variety Furthermore, the literature identifies the
of topics and approaches, the literature60 61 main characteristics of effective place-based
identifies a series of guiding principles that approaches62, which include:
are shared by place-based interventions Multilevel approaches that focus on
regardless of context, which include: individual need and larger contextual
factors.
52Churchill, B., Doherty, Y. & Hansen, E. (2012) People based-service-delivery-initiatives/executive-summary (last
and Place: Developing a Research Program for accessed 18th Jan 2018).
58
Understanding and Addressing Place-based Health Australian Institute of Family Studies (2010). The national
Inequities in Tasmania, University of Tasmania/Department evaluation of the Communities for Children initiative . Family
of Health and Human Services: Tasmania. Matters No. 84. https://aifs.gov.au/publications/family-
53Yeboah, D.A. (2005) A framework for place based health matters/issue-84/national-evaluation-communities-children-
planning Australian Health Review , 29: 1, pp.30-36. initiative (last accessed 18th Jan 2018).
54 59
Department of Education (2015) An Overview of Child United States Environmental Protection Agency (2014).
and Family Centres: Partnership for Sustainable Communities: Five Years of
https://documentcentre.education.tas.gov.au/Documents/O Learning from Communities and Coordinating Federal
verview-of-Child-and-Family-Centres.pdf (last accessed 18th Investments, https://www.epa.gov/smartgrowth/partnership-
Jan, 2018). sustainable-communities-five-years-learning-communities-
55Klein, H. Neighbourhood renewal: revitalising and-coordinating (last accessed 18th Jan 2018).
disadvantaged communities in Victoria Public 60Centre for Community Child Health (2011) Place-based
Administration Today, 1: 1: pp.20-29. approaches to supporting children and families, CCCH
56Department of Health (2016) Support for Day to Day Policy Brief No. 23, Centre for Community Child Health,
Living in the Community: Hospital: Parkville, Victoria.
http://www.health.gov.au/internet/main/publishing.nsf/conte 61Department of Health and Human Services (2012) Place-
nt/mental-d2dl (last accessed Jan 18 th, 2018). Based Approaches to Health and Wellbeing Issues Paper,
57Australian Institute of Family Studies (2015) Tasmanian Government: Hobart, Tasmania.
62
Commonwealth Place-Based Service Delivery Initiatives, Centre for Community Child Health (2014) The evidence:
Key Learnings project, Research Report No. 32: what we know about place-based approaches to support
https://aifs.gov.au/publications/commonwealth-place- : Centre for Community Child Health,
, Parkville, Victoria.
Page | 18 Community services of the future: An evidence review Collaboration and improved evaluations. It is therefore challenging to
communication between conclusively demonstrate an impact6667.
communities and services.
Varying forms of evaluation methods have
Prioritising the co-design of services been utilised to measure the impact of
creating opportunities for the
place-based approaches, including
community. formative, summative, impact and
Utilising and building on community developmental approaches68.
strengths and competencies to
create sustainable change.
Tailoring services to meet local
needs. measurement methods]
Having adequate time and fall short of capturing the
resourcing. full range of policy issues,
Using evidence-based interventions local perspectives, and
with a clear theory of change. learning processes at play
when governments seek
to enable bottom-up
Evaluations and the evidence base
community
Place-based services and systems have development.
faced several challenges in order to
demonstrate their effectiveness. There are
numerous difficulties that have arisen from There is a clear tension between the
past attempts at evaluations, including approaches, characterised by attempts to
poorly designed methodologies and the
inherent challenges of demonstrating that utilise more process and community
causality with complex multifaceted issues63. experience focused designs69. The literature
The existing research is varied with evidence identifies the further development of
of place-based approaches having evaluation methods as an area that requires
measurable improvements in some cases64, significant attention in order to demonstrate
but also questionable impacts in others65.
Addressing issues like health inequality and performance measurement serve
through place-based services for example, primarily as management tools for decision,
may take several generations or involve making and accountability purposes. They
causal factors beyond the scope of short fall short of capturing the full range of policy
term place-based approaches or issues, local perspectives, and learning
processes at play when governments seek to
63Wilks, S., Lahausse, J. & Edwards, B. inequalities work? A systematic review of evidence Critical
(2015) Commonwealth place-based service delivery Public Health, 17: 4, pp.317-335.
initiatives: Key learnings project, Australian Institute of 67Griggs, J., Whitworth, A., Walker, R., McLennan, D. &
Family Studies: ACT. Noble, M. (2008) Person- or place-based policies to tackle
64Neighbourhood Renewal Unit (2005) Research report 17: disadvantage?: not knowing what works , Joseph Rowntree:
NDC 2001 2005 an interim evaluation, The Stationery York, UK.
Office (TSO): London: http://extra.shu.ac.uk/ndc/ (Last 68 Wilks, S., Lahausse, J., & Edwards, B.
accessed 18th Jan, 2018). (2015) Commonwealth place-based service delivery
65Pastor Jr, M., Benner, C. & Matsuoka, M. (2015) This initiatives: Key learnings project : Australian Institute of
could be the start of something big: How social movements Family Studies, ACT.
69
for regional equity are reshaping metropolitan America , Kelly, T. (2010) Five simple rules for evaluating complex
Cornell University Press: New York. community initiatives Community Investments, 22:
66 Macdougall, C. 1,pp.99-22, p.36: www.frbsf.org/publications/community/
(2007) Do area-based interventions to reduce health investments/1005/T_Kelly.pdf
Page | 19 Community services of the future: An evidence reviewenable bottom-up community elements needed in an evaluation, most of
70
which are absent in the field, including:
Developmental methods have been the Causality Evaluating place-based
focus of recent literature given their services needs to be done using
suitability in responding to the needs of international best practice such as
complex and constantly evolving service matched comparison areas,
systems and communities71 72. The method longitudinal data and sophisticated
prioritises a continuous and collaborative statistical analyses since using
approach to evaluation that is iterative and randomised trials is difficult.
developed concurrently with the program. In A theory of change Evaluations
doing so it provides a more flexible and require a clear program logic to
inclusive approach for evaluating innovative demonstrate the link between goals,
service systems. actions and outcomes so that they
can be measured.
Another key and emergent concept is that of
contribution analysis73. Contribution analysis Attribution Considering the
is a more recent approach to evaluation that influence that other programs at a
can provide a systematic process for local, state or national level may
determining the effectiveness of place-based have when trying to determine the
services. The focus is on determining the effectiveness of a program, as there
causal links between complex issues, may be several overlapping services
communities, interventions, theories of operating in the one area to address
change and outcomes74. a similar issue
Residential mobility Any methods
utilised need to account for
Another key and population flows into and out of the
emergent concept is that area in determining whether the
of contribution analysis. system is effective
Cost-effectiveness Analysis of the
costs related to the provision of
In 2015, Wilks et al75 compiled a wide- services, including clarity about the
ranging analysis of Commonwealth place- long-term benefits.
based service delivery initiatives, with an
emphasis on both local and international
examples of programs and their evaluation.
The authors highlight the importance of
evaluation for place-based approaches. In
their analysis they identified five critical
70Bradford, N., and Chouinard, J. (2010). Learning through 73 Stocks-Rankin, C.-R. (2014) Reflective Literature Review
Evaluation? Reflections on Two Federal Community of Contribution Analysis [online]
Building Initiatives. The Canadian Journal of Program http://blogs.iriss.org.uk/contribution/files/2015/06/Reflective
Evaluation 24, no. 1: 55‐77. -Literature-Review-of-Contribution-Analysis-Stocks-Rankin-
71 Bellefontaine, T. & Wisener, R. (2011) The Evaluation of 2014.pdf
Place-Based Approaches: Policy Horizons, Canada. 74 Bellefontaine, T. & Wisener, R. (2011). The Evaluation of
http://www.horizons.gc.ca/en/content/evaluation-place- Place-Based Approaches. Canada: Policy Horizons, op cit.
75Wilks, S., Lahausse, J. & Edwards, B.
based-approaches (Last accessed 19th Jan, 2018).
72
Patton, M.Q. (2011). Developmental Evaluation: Applying (2015) Commonwealth place-based service delivery
Complexity Concepts to Enhance Innovation and Use: The initiatives: Key learnings project , Australian Institute of
Guilford Press, New York. Family Studies: ACT.
Page | 20 Community services of the future: An evidence reviewCase studies
To better contextualise some of the points raised in this paper, two specific examples of place-
based approaches both locally and internationally help to demonstrate what such approaches
entail and what they can achieve.
New Deal for Communities - UK
The NDC program was launched in 1998 by the British government with the aim of reducing
1
. The
program operated for 10 years spending £1.71bn on supporting locally developed strategies
that led to over 6,900 services or projects.1 The program sought to achieve its main aim by
establishing partnerships in 39 areas, each region with approximately 9,900 people, to
achieve six key objectives.1
Transform the 39 areas over 10 years
Achieving holistic change in relation to three place-related outcomes: crime,
community, and, housing and the physical environment, and three people-related
outcomes: education, health, and unemployment
tween these 39 areas and the rest of the country
Achieve value for money transformation of these neighbourhoods
Secure improvements by working with other delivery agencies such as the police,
Primary Care Trusts, schools, JobcentrePlus1, and their parent local authority
Sustain a local impact after NDC Program funding ceased
Using an outcomes-based approach the final evaluation report1identified NDC areas as
unemployment, community and housing and the physical environment; for 26 out of the 27
1
recognition that this change was brought about because of NDC initiatives. The evaluation
found that more broadly the NDC had: begun to reduce the gaps in NDC areas compared
with the rest of the country, the program was cost effective, partnerships between service
providers improved, efforts to engage local communities were positive but required significant
consistency and commitment.
While the program had a demonstrated positive impact in certain regards, further analysis of
longitudinal and cross-sectional data has highlighted some limitations in the findings from the
evaluation and the disparity between different NDC areas.1 Further criticism centred on the
level of community participation in the program.1Go Goldfields - Australia
Go Goldfields is a place-based approach to service delivery initiated by The Central Goldfields
Shire Council in 2010. Their aim was to develop a collaborative approach to addressing some
of the pressing issues facing the local area1. The program is an alliance of over a dozen
organisations and receives funding from the Victorian state government and other partners.
In Victoria, the Central Goldfields Shire has rated 79th out of the 79 local government areas
on numerous health and social indicators, highlighting the need for a more holistic and
place-based approach.1 The main outcomes were:
a reduction in the incidence of notifications to DHS Child Protection Services
improved communication and literacy skills, more opportunities and positive life
experiences for children and their families
improved community connectedness for children, youth and families
improving youth connection to appropriate training and education to achieve
employment outcomes;
increased breastfeeding rates.
The result is a series of action groups, programs, services, health and educational campaigns
and strategies aimed at achieving the outcomes. Further details about the programs and the
groups can be found on the Go Goldfields website1.
In 2015, the first evaluation report was published identifying possible improvements in some
areas and clear challenges and limitations, characteristic of several place-based
approaches1. The evaluation applied a Collective Impact framework, focusing on process and
experience. Several methods were utilised with qualitative and quantitative data collected
using surveys, interviews and secondary statistical data analysis. The evaluation report
identifies a greater awareness from the community of early childhood communication and
literacy needs, some improvement in childhood development data, improved service
coordination and greater opportunities for social connections. Challenges are predominantly
characterised by the difficulties of programs to address intergenerational issues (impact of
parent literacy on child literacy), the impact of broader structural issues (employment
opportunities) and poor levels of engagement from the community (potentially undermining
While the program has clear benefits in some respects, the limitations highlight some of the
main issues that need greater consideration into the future.You can also read
