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An integrated approach toearly childhood development

Background Paper


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About The Benevolent Society

The Benevolent Society is Australias oldest charity. Established in 1813 we have been caring or

Australians and their communities or nearly 200 years. We are a secular, non-prot, independentorganistation working to bring about positive social change in response to community needs. Our

purpose is to create caring and inclusive communities and a just society.

Prepared or The Benevolent Society

Prepared by Centre or Community Child Health, Melbourne

Written by Dr. Tim Moore (Senior Research Fellow) and Alexandra Skinner (Project Ocer)

September 2010

ISBN 978-0-9807720-3-6

The Benevolent Society

Level 1,188 Oxord StreetPO Box 171Paddington NSW 2010

t 02 9339 8000 02 9360 2319e [email protected]


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Background PaperAn integrated approach to early childhood development

September 2010

Contents

Executive Summary ...................................................................................................................... 1

1. Introduction ............................................................................................................................ 3

2. The big picture: climate change and social climate change .................................................. 4

3. Moving towards integrated service delivery: government policies and initiatives ................. 6

4. Service systems and government support: what works or children and amilies ................. 8

5. Building an integrated service system: what we can do ...................................................... 12

6. Forms o collaboration and integration ................................................................................ 15

7. Existing models o service integration .................................................................................. 20

8. Improving service integration: what we have learned .......................................................... 25

9. Priorities and recommendations ........................................................................................... 29

10. Conclusion ............................................................................................................................ 35

11. Reerences ............................................................................................................................ 36


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September 2010

Major social, demographic and economicchanges in Australia over the last 50 yearshave dramatically altered the conditionsin which amilies are raising children.

There is evidence that a signicantnumber o children are acing worseningdevelopmental and social outcomes as aresult o this social climate change.

The system o services or children andamilies is struggling to cope with amiliesincreasingly complex needs in the ace othis rapid societal change. Services areragmented, and the system is dicult oramilies to understand and access. Theservice system needs to be recongured to

better meet amilies needs.

Research suggests that, while an integratedservice system would not directly improveamily unctioning and childrens wellbeing,it would contribute to those outcomes byimproving access to services and enablingearly identication o problems.

There are our levels at which integrationneeds to occur:

Government/policy integration is basedon the recognition that the wellbeing ochildren is not the responsibility o anyone department. At this level, policy andplanning are integrated across governmentportolios, departments and agencies.

Regional and local planning integrationinvolves the establishment o an earlyyears partnership group to drive localintegration. Strategies include mappingcommunity assets and needs; developingan integration plan; and simpliying

parental access to services throughsingle entry points. An important ocusis the linking o specialist services withmainstream or universal services.

Service delivery integration can take theorm o virtual or co-located integration.Dierent orms o service level integrationall along a ve-point continuum ranging

rom coexistence (where services operateindependently) to ull integration (whereservices merge completely to orm a newentity).

Teamwork integration requiresproessionals to work in teams withmembers o dierent disciplines. Types oteam integration range rom unidisciplinaryteamwork (where one discipline attemptsto meet all the needs o amilies) totransdisciplinary teamwork (where team

members share roles and cross disciplineboundaries).

Two o the most notable eorts to integratechild and amily services are Sure Start inthe UK and Toronto First Duty in Canada.Both models bring together a range oservices in one centre, including earlyeducation and care, parenting support,child and amily health services, and helpwith employment. Evaluations o bothmodels have ound benets or children andamilies.

There is recognition in Australia o the needor an integrated child and amily supportsystem. Over recent years there has beenan unprecedented level o collaborationbetween ederal and state governmentsin developing policies and rameworksor early childhood services. While acomprehensive, integrated child and amilysupport system has yet to be developed,there are some promising initiatives.

At a national level, The Department oFamilies, Housing, Community Servicesand Indigenous Aairs established itsCommunities or Children (C4C) initiativeto promote a local partnership approach

Executive summary


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to planning and delivering services.Established in 45 sites, the program aimsto improve childrens health, saety andwellbeing in disadvantaged communities. A

local non-government organisation (NGO)works with the community to identiy needsand develop appropriate strategies. ThisNGO acts as a broker, engaging otherlocal organisations to help deliver thosestrategies. The model aims to increaseservice coordination and collaboration.

At a regional level, integration initiativesinclude Families NSW, a servicecoordination program established in 1998which attempted to integrate planning at

the government level. However, subsequentchanges to the program have reducedits eectiveness as a comprehensiveregional planning process. Also in NSW, theSchools as Community Centres programruns 51 projects in partnership withamilies, communities and agencies. It runssupported playgroups and activities relatingto early literacy and transition to school.

In Victoria, the Best Start program buildslocal partnerships between parents,services and government agencies topromote better service coordination andjoint strategic planning. The Primary CarePartnerships initiative in Victoria aims toimprove integration between services withinthe primary health care system.

International and Australian experiences ointegration provide some evidence o theimpact that integration has and how bestto achieve it. Evidence o the impact ointegration is somewhat limited. Researchsuggests that it is the quality, rather

than type, o integration that matters orimproving outcomes. Integrated workingonly benets amilies i it results in higherquality interventions.

There is more evidence about the processo integration, which conrms that it is achallenging process requiring commitment,enthusiasm and careul planning.

Research highlights a number o barriersto, and actors that promote, successulcollaboration. These include issues relatingto management and leadership, nancingand resourcing, timerames, and culturaland ideological dierences.

There are a number o next steps thatwould lead to greater integration oAustralias child and amily service system.These include embedding targeted servicesinto mainstream services; early years

partnerships that drive local integration; andgovernance and unding models that enablesustainable partnerships. This paper makesrecommendations to governments andservice delivery organisations on how bestto move towards integration.


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1. Introduction

This paper was commissioned by TheBenevolent Society (TBS) to provide adviceon how to move towards greater integrationo the various elements o support and/

or services needed by children and theiramilies.

The paper was prepared by Dr. Tim Moore,Senior Research Fellow, with assistancerom Alexandra Skinner, Project Ocer,rom the Centre or Community Child Health(CCCH), Melbourne. Preparation o thepaper was based on a number o sources:reviews and syntheses o relevant literature(both peer-reviewed and grey literature);reviews o relevant Australian ederal and

state policies and initiatives; reviews orelevant international policies and initiatives;and a workshop with TBS managers

and policy sta. The paper also drawsupon CCCHs considerable experience insupporting the development o integratedearly childhood services.

The paper includes: a synthesis o evidenceregarding societal change and its impacton children, amilies and communities;the response o governments to thesechanges; and what is known about eectiveservices, service systems and governmentpolicies. The paper also includes a reviewo evidence regarding integrated servicedelivery, service systems and policies,and an analysis o current opportunities inNSW and Queensland or greater service

integration.


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2. The big picture: climate change

and social climate change

The changes that have occurred overthe past 50 years have been so rapidand so ar-reaching that they have hada dramatic impact on the physical well-

being o the planet (in the orm o climatechange) (Flannery, 2005; Garnaut, 2008;Intergovernmental Panel on Climate Change,2007; Steen et al., 2004), as well as on thephysical and psychosocial well-being osocieties (social climate change)(Moore,2009).

The eect o these changes can be seenin the health and well-being o childrenand young people. While most children aredoing well, there is evidence o worsening

or unacceptably high levels o problemsin a minority o children (Bruner, 2004;Eckersley, 2008; Li, McMurray & Stanley,2008; Perrin et al., 2007; Stanley et al.,2005; Richardson & Prior, 2005). Theseproblems are evident across all aspectso development, health and well-being,including mental health (eg. depression,suicide, drug dependence), physicalhealth (eg. asthma, obesity, diabetes,heart disease), academic achievement (eg.literacy levels, retention rates, educationaloutcomes), and social adjustment (eg.employment, juvenile crime). These problemsare disorders o the bioenvironmentalinterace (Palrey et al., 2005) rather thanconditions with separate or singular causes,and the developmental pathways that lead tomost o these outcomes can be traced backto early childhood. This is refected in thesignicant numbers o children who arrive atschool poorly equipped to take advantageo the social and learning opportunities thatschools provide (Centre or Community ChildHealth and Telethon Institute or Child Health

Research, 2007, 2009).

The proound social changes that haveoccurred over the past ew decades havealso altered the circumstances in which

amilies are raising young children parenting has become more challenging, andthe stakes are continuing to rise the more welearn about the importance o the early years

and the more we understand about the skillsthat are needed to unction successully in acomplex interconnected world. The currentservice system was designed at a time whenamily circumstances were simpler andparenting less challenging, and is strugglingto meet all the needs o all amilies eectively(Moore, 2008).

Specic problems aced by the servicesystem include the ollowing (Moore, 2008):

the service system is having diculty

providing support to all amilies who areeligible there are waiting lists or manyservices

services cannot meet all the needs oamilies that they serve - no single serviceis capable o meeting the complex needso many amilies

amilies have diculty nding out aboutand accessing the services they need there is no single source o inormationabout relevant services

services are not well integrated withone another and are thereore unable toprovide cohesive support to amilies

services have diculty tailoring theirservices to meet the diverse needs andcircumstances o amilies

services are typically ocused and/orunded on the basis o outputs ratherthan outcomes, and thereore tend topersist with service delivery methods thatmay not be optimally eective

services are typically treatment-orientedrather than prevention - or promotion-ocused, and thereore cannot respondpromptly to emerging child and amilyneeds


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child care and early childhood educationservices are unded and run separately

government departments, research

disciplines and service sectors tend towork in silos

responsibility or provision o servicesto children and their amilies is spreadacross three levels o government -ederal, state, and local - with dierentplanning processes and undingpriorities

most specialist intervention services arealready underunded, and it is lookingincreasingly unlikely that they can everbe ully unded in their present orms.

As a result o the diculties that the currentsystem o services is experiencing, manychildren are not receiving the additional helpthey need (Sawyer et al., 2000; Sayal, 2006).It is oten those with the greatest needthat are least likely to be able to accessavailable services (Fonagy, 2001; Oord,1987; Watson et al., 2005).

Perhaps the most dramatic examples o theproblems being experienced by traditional

service systems is the crisis acing childprotection systems (Scott, 2006; ODonnellet al., 2008; Allen Consulting Group, 2009).However, all other service sectors areexperiencing similar challenges, and orsimilar reasons.

Accompanying these changes has been theemergence o a class o complex problemsaecting children and amilies that cannotbe eectively addressed by individualinterventions or orms o service. The poor

developmental and social outcomes weare witnessing in our young people needto be understood as the cumulative resulto complex interactions between a hosto social and other actors (Kearns et al.,

2007). These complex maniestationsare sometimes reerred to as wickedproblems, not in the sense o them beingevil in some way, but in the sense o them

being complex and dicult to solve, andrequiring action on multiple ronts and levels(Australian Public Services Commission,2007; Conklin, 2006; Rittel & Webber, 1973).

In the light o these problems, it hasbecome increasingly obvious that the earlychildhood and amily support system needsto be recongured to meet the needs ocontemporary amilies more eectively.The next section outlines the ways inwhich governments have responded to this

challenge.


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September 2010

. Moving towards integrated service delivery:

government policies and initiatives

All developed nations have taken actionto address these changed circumstances.Some have been driven by a growingawareness o the ways in which some

people within society are ailing to benetrom the changed social and economicconditions and are thereore achievingpoorer outcomes. This has, in turn, led togeneral public policy initiatives in Australiaand elsewhere to address social exclusionand promote a truly inclusive society.

Other initiatives have ocused on the needso young children and their amilies, andways o integrating early childhood andamily support services. Sometimes these

two goals are addressed within the sameinitiative. International examples o suchresponses include the UKs Every ChildMatters policy and Sure Start initiatives, andCanadas Toronto First Duty program.

In Australia, there have been a number oederal initiatives over the past decade orso. These include the Stronger Families andCommunities strategy (and its Communitiesor Children initiative) and the currentGovernments Early Childhood Developmentstrategy. The Federal Government hasalso worked with the Council o AustralianGovernments (COAG) which has endorseda number o national policies and initiativesaimed at young children and amilies. AllAustralian States have also taken actionto develop early childhood policies andintegrate early childhood services.

The move towards more integrated servicedelivery has been driven by a growingawareness o how ragmented services oryoung children and their amilies are, and

how that ragmentation undermines thecapacity o the service system to supportchildren and amilies eectively. All theproblems identied earlier wherebyplanning, unding and services delivery are

managed by dierent levels o government,dierent departments and dierentagencies all operating independently o oneanother result in a service system that

can be dicult or amilies to understandand access. The amilies that are mostdisadvantaged by this situation are thosethat are most vulnerable whether becausethey lack the skills and condence tonegotiate the system, or because they areunamiliar with the culture and language,or because they are isolated and lack thesocial networks that would help them ndand use the services that are available, orbecause they have multiple problems andneed help rom many sources.

The ragmentation o services isparticularly problematic or the amilies ochildren below school age because thereis no universal service that all amiliesuse during these years. All children areknown to the service system at birth andat school entry, but the contact they havewith early childhood and other servicesbetween those two points varies greatly.Some amilies make regular use o thevarious health, early childhood and amilysupport services during these years, whileothers make little or no use o them, eveni they have concerns about their childrenor are experiencing amily diiculties(Carbone, Fraser, Ramburuth and Nelms,2004). In such cases, the service systemcannot respond promptly to issues asthey arise and may only become involvedlater when the problems have becomemore entrenched and severe. The lack oa universally used early childhood servicehas been one o the problems that movesto integrate services are intended to

address.

Besides the moves to integrate services,the various policies and initiativesundertaken by governments in Australia


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and elsewhere share a number o commoneatures. These include:

nding more eective ways o reaching

vulnerable children and amilies ensuring that all children arrive at school

ready to learn shiting services to a promotion /

prevention ocus reducing child protection rates monitoring childrens development and

well-being more eectively improving the quality o early childhood

services increasing the use o evidence-based

practices.

Many o these themes can be seen in therecommendations emerging rom recentreviews o child protection systems invarious jurisdictions (eg. COAG, 2009;Wood, 2008) and other analyses (eg. AllenConsulting Group, 2009; Higgins and Katz,2008; ODonnell, Scott and Stanley, 2008;Scott, 2006). These all point to the same seto solutions: a move to preventive practices,a ocus on promoting the well-being o allchildren, and a coordinated approach toaddressing problems as they emerge. Forinstance, the recent Report o the SpecialCommission o Inquiry into Child ProtectionServices in NSW supports the premise oshiting child protection to a preventionapproach that utilises a range o services toachieve that goal. The report states:

child protection systems should

comprise integrated universal,

secondary and tertiary services, with

universal services comprising the

greater proportion. They should be

delivered by a mixture o the non-government sector and state agencies,

with DoCS being a provider o last

resort. (Wood, 2008)

Similarly, the Council o AustralianGovernments new National Frameworkor Protecting Australias Children (COAG,2009) takes the view that protecting children

is everyones business, and that Australianeeds to move rom seeing protectingchildren merely as a response to abuse andneglect to one o promoting the saety andwell-being o children.

Another common eature o all thesepolicies and initiatives is that none o themhave succeeded as yet in making signicantimprovements in child and amily outcomes.One reason or this is that our eorts toalter the circumstances in which amilies are

raising young children are relatively modestso ar, and have not been in place longenough to begin to counteract the eectso social climate change. Another reason isthat we have not yet clearly identied howto recongure the service system so as tosupport amilies more eectively. The nextsection addresses this question.


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. Service systems and government support:

what works or children and amilies

To understand ully how best to supportyoung children and their amilies, we needto take into account what we know aboutchild development, amily unctioning,

community unctioning, direct servicedelivery, service systems and the role ogovernment. These do not develop orunction independently o one another, butconstitute dierent levels o a complexsocial ecological system in which each levelaects and is aected by the levels closestto it (Bronenbrenner, 1979; Bronenbrenner& Ceci, 1994; Bronenbrenner & Morris,1998).

Because the ocus o this paper is on how

to move towards greater integration o thesupports and services needed by childrenand their amilies, we will concentrate onthe last two o these key elements only:what is known about service systems andabout the role o government.

Service systems

What do we know about how best toorganise services into a system thateectively supports amilies o young

children in rearing their children asthey (and we) would wish? There isa considerable research literature onwhat makes service systems eectiveand what problems parents o youngchildren experience in accessing andusing services. Based on analyses andresearch reviews by Allen ConsultingGroup (2008), Beresord & Hoban (2005),Boston Consulting Group (2008), Centreor Community Child Health (2007, 2008,2009), Fine et al. (2005), Lewis (2010),Pope & Lewis (2008), Soriano et al. (2008),

Watson (2005), and Watson et al. (2005),the key eatures o eective integratedservice systems or vulnerable amilies areas ollows:

Universal and inclusive service base.The core services are available toeveryone and designed to be inclusive,non-stigmatising and welcoming. The

usual approach to addressing the needso vulnerable or exceptional amilieshas been a targeted approach whichinvolves supplementing a relativelynarrow band o universal services (eg.maternal health services) with a rangeo targeted programs that provideadditional services to individuals,groups or localities identied as beingat risk. There are good grounds, bothempirical and theoretical, or adopting auniversal approach to service provision,

strengthening the range o universalservices and providing additionalservices in response-based ashion(according to emerging needs ratherthan risks).

Inormation provision. Parents haveaccess to inormation in various ormsregarding the community acilities andproessional services that are available.

Range o services. Families haveaccess to a broad range o interventionswhich include both practical, materialservices and more complex work (suchas enhancing parenting skills), includingopportunities to be engaged in theirchildrens learning.

Multiple interventions. Programs usingmultiple interventions addressing severalrisk areas work better than those using asingle intervention strategy.

Service redundancies. Services areprovided in a range o ormats andlocations to suit the dierent needs and

preerences o diverse groups. Thus,parenting services might be availablein ormal (eg. Triple P) and inormal (eg.acilitated playgroups) ormats. Multipleormats are needed because o evidence


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to suggest that the most vulnerableamilies may be deterred rom usingchildrens centres i they perceive acritical mass o more afuent, assertive

and condent parents to be dominatingthe use o services.

Accessibility. Services are made asaccessible (in all senses, includinggeographical, cultural and psychologicalaccessibility) as possible. Activeassistance (eg. with transport orinterpreters) is provided as required.

Multiple single entry points. Thereare multiple entry points and no wrongdoor: whatever service a child is

brought to should either provide help, orhelp nd a more suitable service that iseasy to access.

Sot and hard entry points. A mixo sot and hard entry points to theservice system is provided. Universalservices can be used to provide animportant sot entry point o rst contact,whereby parents can access support tomore specialised services.

Integrated services. Some coreservices are integrated, either as a

virtual network or an actual co-locatedservice (as in service hub models andchildrens centres).

Embedded specialist services.Specialist or targeted services areembedded in universal services (eg.schools, maternal and child healthcentres, churches, libraries and healthclinics).

Active / assertive outreach. There areoutreach services designed to nd and

build relationships with vulnerable andmarginalised amilies, and link them withservices that match their needs andpreerences.

Mentoring. Experienced parents are

recruited to act as mentors or newparents. Mentoring helps to achievepositive outcomes with various clientgroups, such as young parents and

isolated parents.

Community-based early yearspartnerships. The planning andmanagement o integrated servicesystems requires the establishmento community-based early yearspartnerships.

Articulation o a shared vision andachievable goals. It is important to havea strong vision with clear objectivesand achievable goals. A shared vision

provides a platorm or building sharedresponsibility and accountabilitybetween organisations and sectors,providing a base or collective action,planning and service delivery. Problemsarise when policy objectives are vague orthere are too many goals to be reachedin a short time.

Facilitation capacity. Eective servicesystems usually have an identiedperson or agency that is unded toacilitate / coordinate collaboration

between services, and support the worko early years partnerships.

Integrated governance arrangements.The sustainability o community-based early years partnershipsdepends upon establishing integratedgovernance arrangements that involveall stakeholders and provide a structureor leadership and processes or undingand accountability.

Building a supportive culture. Eectiveintegrated systems require a supportiveculture based on collaboration betweenservices, mutual respect and trustbetween proessional groups andproviders, and shared responsibility orvulnerable amilies and children.


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Active community participation.Parents and other community membersshould be active participants in theplanning, delivery and evaluation o

integrated services.

Commitment and support rom seniorlevels o government. The success ointegrated service networks depends onsupporting coordination in the eld withparallel coordination within governmentand planning bodies.

In addition to these structural propertieso eective integrated service systems, anumber o vital process qualities have been

identied: how services are delivered is asimportant as what is delivered. Key processqualities include:

Engagement with parents. The successo integrated services ultimately dependsupon the level o engagement and thequality o the relationships establishedbetween proessionals and parents, atboth individual and group levels.

Partnerships with parents. Eectiveservices work with parents as partners

using amily-centred practice principles. Empowerment o parents. Eective

services help parents develop new skillsand competencies in meeting the needso their children and amilies, and inmaking ull use o early childhood andamily support services.

With these structural and process eatureso eective service systems in mind, whatdo we know about the extent to whichearly childhood and amily support servicesin Australia are organised in the waysthat eectively support amilies in theirchildrearing roles?

While Australia has a well-establishedtradition o providing early childhood andamily support services, these are notgenerally organised into service systems

that have the eatures listed above. Fora start, the service systems are not trulyuniversal (in the sense o being available toall people in all localities) or ully inclusive,and levels o provision vary between states.Our service systems also lack single entrypoints, outreach services or vulnerableamilies, governance structures or earlyyears partnerships, and unding or aacilitator role. A good start has been madeon some o the other key eatures such asdeveloping integrated hubs or centres, and

establishing community-based early yearspartnerships but these initiatives have notyet become a consistent eature o earlyyears service systems across the country.

Government policies

and unding

What contribution can government make tosupport amilies, communities and servicesin rearing young children as they wouldwish? The overall role o government is

to try and create the conditions that willenable amilies to raise their children asthey (and we) would wish. Governmentsability to do this eectively is limited by anumber o actors, the main one being thatgovernments do not have ull control overall the relevant conditions. This is becausemany are emergent conditions eitheremergent group patterns o behavior (eg.changing birth rates), or conditions thatare side-eects o other policies or socialchanges (eg. ragmentation o communities)

and thereore not always predictable.

However, governments are able to provideimportant orms o support that orm parto the conditions under which amilies


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are raising young children. As with directservice delivery, two aspects o governmentpolicy development and unding areimportant: what is delivered and how it is

delivered.

Regarding what is delivered, governmentscan provide direct nancial support toamilies, und various child and amilyprograms, and shape the way servicesare delivered through policies, curriculumrameworks, and quality assuranceprocesses. Regarding how governmentdoes this, there is evidence that themanner in which government develops anddelivers policy and support is important

or how eective it is in achieving desiredoutcomes. In todays rapidly changingworld, it is not possible or government topredict all patterns o behaviour or need,and it thereore needs to be constantlyworking with amilies, communities andother levels o government, and monitoringsocial indicators, so as to be able to adjustunding and policies to match emergingconditions. This requires a balance otop-down and bottom-up decision-making processes, and greater devolutiono responsibility to local services andcommunities.

What do we know about the extent to whichgovernments are eectively supportingamilies, communities and services inenabling amilies to raise their children asthey (and we) would wish?

Australian governments, regardless opolitical persuasion, have maintained atradition o providing both direct undingto parents (income tested to ensure most

is targeted at lower-income amilies) aswell as unding a range o universal andtargeted programs. Over the last ew years,there has been an unprecedented level ocollaboration between ederal and state

governments in developing policies andrameworks or early childhood and amilysupport services.

Many o the recent initiatives at bothstate and ederal levels have been place-based, and have allowed a signicantmeasure o local determination o needsand outputs within broad state- or ederal-level outcomes rameworks. It will takesome time beore these initiatives yieldmeasurable benets or amilies. Moreover,it remains a challenge or governments toknow how to share decision-making andresource allocation with other governmentsand with communities while maintaining

accountability or outcomes and publicexpenditure.

Conclusions

In the light o rapid and ongoing socialchange, it has become increasinglyobvious that the early childhood andamily support system needs to berecongured to meet the needs ocontemporary amilies more eectively.

There is a considerable research

literature on what structural and processqualities make service systems eective how services are delivered is asimportant as what is delivered.

While Australia has a well-establishedtradition o providing early childhood andamily support services, these are notgenerally organised into service systemsthat have the structural and processeatures o the most eective systems.

Government services need to become

more responsive to the emerging needso children and amilies, and thereoremore fexible.


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. Building an integrated service system:

what we can do

Outcomes or children and amilies arethe result o a wide range o actors, bothdirect and indirect, that interact with oneanother and cumulatively aect the course

o childrens development and wellbeing.Similarly, eorts to improve outcomesmust involve a wide range o actions andinterventions. No single intervention canhope to achieve sustainable improvementson its own.

In Victoria, the Centre or CommunityChild Health has been working or thepast decade on understanding theactors that aect child development,and has developed a model o what

needs to be done to improve outcomesor children and to support theiramilies more eectively. This modelproposes that action is needed on threeronts simultaneously: building moresupportive communities, creating abetter coordinated and more eectiveservice system, and improving theinterace between communities andservices (Moore, 2008). Within each othese spheres o action, we can identiya number o strategies or interventions.Each intervention is based on evidencethat the issue addressed is o importanceor child development and/or amilyunctioning, and that the intervention itselis backed by research evidence and/orstrong program logic.

The three spheres o action

Building more supportive communities.As a result o the pervasive economic,social and demographic changes that haveoccurred over the past ew decades, there

has been a partial erosion o traditionalamily and neighbourhood supportnetworks. This has let many parents oyoung children with relatively poor socialsupport networks and thereore more

vulnerable. There are a number o generalstrategies or addressing this problem,including providing multiple opportunitiesor amilies o young children to meet,

ensuring that streets are sae and easilynavigable, and ensuring that there is anecient and aordable local transportsystem that gives amilies ready accessto services and to places where they meetother amilies.

Creating a better co-ordinated and

more eective service system. In lighto the diculties that services havein meeting all the needs o all amilieseectively, the service system needs to

become better integrated so as to be ableto meet the multiple needs o amiliesin a more seamless way. This involvesthree interlinked elements: building astrong universal service system, backedby a well-integrated tiered system ouniversal, secondary and tertiary services,strengthening direct services to children,and strengthening support services toamilies. There are a number o specicinterventions within each o these elements.

Improving the interace between

communities and services. The existingservice systems are unable to respondpromptly to the emerging needs o allparents and communities, partly becauseo the lack o eective channels ocommunication. For service systemsto become more responsive, improvedorms o dialogue between communitiesand services are needed. This needsto occur at all levels, involving serviceproviders in their dealings with individualamilies, agencies with their client

groups, and service systems with wholecommunities. Specic interventions includeproviding sta with training in amilyengagement and relationship-buildingskills, employing community links workers


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to build relationships with marginalisedand vulnerable amilies, and creatingopportunities or parents to be activelyinvolved in the planning, delivery and

evaluation o the services and acilitiesthey use.

Each o these interventions needs to beincluded in a comprehensive local plan toaddress the needs o young children andtheir amilies in a particular community.None o the individual interventions on itsown will make a signicant and sustainabledierence to child and amily outcomes;they only do so in concert with other ormso action.

We will now explore the second majorsphere o action, creating a better co-ordinated and more eective service systemin more detail.

Building a better coordinated

and more eective service

system

Building an integrated service systemcan begin with small initiatives, such

as integrating early education and careservices within a long day care program.However, the ull benets o integratedservice delivery can only be gained bycreating an integrated service system thatinvolves a wide range o services that workdirectly or indirectly with young childrenand their amilies. What ollows is a listingo the strategies or interventions that areinvolved in building an integrated servicesystem. These strategies are taken rom aseries o guides developed by the Centre

or Community Child Health as part o itsPlatorms Service Development Framework(2009).

As elaborated in these guides, the majorstrategies involved in building an integratedservice system are:

establishing a community-based earlyyears partnership group to overseethe development o integrated servicesystem

gaining agreement regarding an overallvision and specic outcomes that thepartnership is seeking to achieve

appointing a community partnershipacilitator to help build links betweenservices and support the work o thepartnership group

documenting community demographics,mapping assets and identiying needs

creating an integrated action andevaluation plan

simpliying parental access to servicesby developing common protocols thatallow amilies to gain access to allservices through single entry points

developing ways in which secondaryand tertiary services can expand theirroles to strengthen the capacity o the

universal system to meet the needs ochildren more eectively

building the capacity o early childhoodand amily support sta to workcollaboratively with parents in monitoringtheir childrens health and development

building the capacity o early childhoodand amily support sta to workcollaboratively with parents in identiyingemerging parenting and amily issues.


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I the strategies just outlined areimplemented as planned, then we canexpect the ollowing immediate benets andoutcomes:

amilies will nd it easier to access earlychildhood and amily support services

service providers will be better inormedabout available services

services will be more eectivelyintegrated, doing more joint planning andservice delivery

parents will be better inormed aboutavailable services and acilities

childrens health and developmentalproblems will be diagnosed earlier

reerral o children with health ordevelopmental problems to specialistservices will be prompter

problems with parenting and amilyunctioning will be recognised earlier

reerral o amilies experiencingdiculties in parenting and meetingamily needs will be prompter.

It should be noted that none o theseoutcomes involve actual changes in child oramily unctioning. What integrating servicesdoes is to provide children and amilieswith more direct and immediate access toa ull range o services, and ensure thatthe service system responds promptly toemerging child and amily problems. Thesedirect outcomes will, in turn, contribute tothe broader outcomes relating to child andamily unctioning that we are ultimatelyseeking to achieve, namely:

improvements in the health, wellbeingand development o the children involved

improvements in their school readiness

improvements in general amilyunctioning o their amilies

improvements in the ability o the

amilies to meet their childrens learningand care needs.

Thus, integrating services is a means to anend rather than an end in itsel. Moreover,it is important to recognise that integratingservices is just one o many other strategies(including other government initiatives) thatcontribute to these broad outcomes. Inevaluating the eectiveness o integratedservice systems, it is important to do so interms o the direct outcomes rather than

the broader outcomes regarding child andamily unctioning.


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September 2010

. Forms o collaboration and integration

The previous section outlined what isinvolved in creating an integrated servicesystem or young children and their amilies.This is one o our dierent levels at which

integration needs to occur: national orwhole-o-government level, regional andlocal planning level, agency or direct servicelevel, and practitioner or teamwork level.For eective integrated services and servicesystems, all our levels need to be involved.

Policy (or whole-o-

government) integration

Sometimes known as joined upgovernment, this involves workingcollaboratively across departments,portolios or levels o government toaddress complex issues which crossindividual agency boundaries (State ServiceAuthority, 2007). According to Valentine etal. (2007), the purpose opolicy integrationis to ensure that:

the program is owned by all therelevant government agencies that havea stake in the wellbeing o children,rather than being seen as the domain o

only one department or portolio

the tensions which are inherent inany such programs are minimised(or example, to ensure that data onnewborns can be shared between healthand non-government organisations

the bureaucratic obstacles toimplementation o the program areaddressed (or example, that schoolscan be opened at weekends to houseamily support programs).

Whole o government approaches aredicult to achieve, needing political willand ongoing high level commitment tohave a chance o succeeding (Choi, 2003;

Homel, 2004). As noted in a recent reporton joined up government by the StateServices Authority in Victoria (State ServicesAuthority, 2007), joined up approaches

need to be balanced with portolio-based,unctional accountabilities. Deliveringgovernment outcomes thereore requiresa mix o the traditional vertical structureso government with cross portolioapproaches.

Another whole-o-government approachtakes the orm o integrating responsibilityor related policy area within a singlegovernment department. The mostrelevant example o this approach is the

move to place early childhood educationand care services under the auspiceso a Department o Education, such ashas recently occurred in Victoria andQueensland, as well as in a number ocountries including New Zealand andSweden (Haddad, 2002; Meade & Podmore,2002; Taguchi & Munkammar, 2003).

Regional and local planning

integration

As discussed in the previous section,this level o integration involves theestablishment o regional or localinteragency planning groups or partnershipsto take responsibility or the creation olocal integrated service systems. The keyaims o an integrated approach to servicedelivery include reduction o duplicationand overlap, accessing limited resourcesand expanding opportunities, increasingeciency and eectiveness, organisationallegitimacy, resolving intractable social

problems (wicked problems) and completingcomplex projects (Keast & Mandell, 2009).

In orming such early years partnerships,there are two key issues to consider: how


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to ensure that all relevant services areinvolved, and how to link the mainstream oruniversal services with the various specialistservices.

In thinking o the rst o these issues whatservices need to be involved it can beimportant to consider the ull range oinfuences on child and amily unctioning,and all those involved in addressing thoseinfuences. These include:

mainstream child-ocused services suchas child care and preschool programs

health services such as maternal andchild health services, GPs, oral health

services, nutritionists etc.

amily support services such asparenting programs, welare and childprotection services, nancial counseling

services or amilies rom CALD andreugee backgrounds

disability services such as earlychildhood intervention services

mental health services such as child andadolescent mental health services, amily

counselling, marital counselling.

Other relevant services include thosethat address the conditions under whichamilies are raising young children, includinghousing and homelessness services,employment services, and transportservices. In addition, there are oten anumber o community-based supportservices provided through cultural groups,aith groups, and volunteer organisations.

The second issue to be considered is howto link the mainstream or universal serviceswith the various specialist services (eg.disability, mental health etc.). In the existingsystem, these specialist treatment services

are mostly located separately rom universalservices; there are reerral bottlenecksthat result in delays in help being provided;and the communication between services

tends to be one way. Services are havingdiculties meeting the needs o all childrenand amilies eectively because they are toodependent upon scarce specialist services.Inevitably, there are delays in children withadditional needs receiving the specialistsupport they need, and many children endup getting little or no help at all (Moore,2009; Sawyer et al., 2000; Sayal, 2006).

The existing service system o universal,targeted and treatment services needs to

be recongured as an integrated and tieredsystem o secondary and tertiary services,built upon a strong base o universal andprimary services (CCCH, 2006; Drielsma,2005; Gallagher et al., 2004; Jordan &Sketchley, 2009; Moore, 2008, 2009;ODonnell et al., 2008; Perry et al., 2007).There have been numerous descriptionso tiered service systems, usually involvingthree or our levels (eg. Gascoigne, 2006,2008; ODonnell et al., 2008; Zeanah etal., 2004). An integrated tiered system sometimes reerred to as a public healthmodel (Bromeld & Holzer, 2008; Jordan& Sketchley, 2009; ODonnell et al., 2008Scott, 2006), and also dubbed progressiveuniversalism (Feinstein et al., 2008) diersin approach rom the current system in anumber o important ways. It can respondto emerging problems and conditions, ratherthan waiting until problems become soentrenched and severe that they are nallyeligible or service. It ocuses on targetingproblems as they emerge through thesecondary and tertiary layers, rather than

people as risk categories, thus avoidingunnecessary stigmatising. It aims to driveexpertise down to universal and secondaryservices, strengthening their capacity todeliver prevention and early intervention


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strategies. It would have outreach bases co-located with universal services to acilitatecollaboration and consultant support.

Service delivery integration

At the direct service level, integrationcan take many orms. These are otendepicted as alling along a continuumrom coexistence to integration (AuditCommission, 1998; Fine et al., 2005;Horwath & Morrison, 2007; Toronto FirstDuty, 2005; Turnbull & Turnbull, 2000;Valentine et al., 2007). A synthesis o theseaccounts yields the ollowing ve-pointcontinuum:

Coexistence involves services operatingindependently o one another, with nosharing o inormation or resources.

Cooperation involves a low-intensity,low-commitment relationship in whichthe parties retain their individualautonomy but agree to share inormation(eg. networking).

Coordination involves a medium-intensity, medium-commitment

relationship in which the parties retaintheir individual autonomy but agree tosome joint planning and coordinationor a particular time-limited project orservice (eg. regional reerral committee).

Collaboration involves a high-intensity,high-commitment relationship in whichthe parties unite under a single auspiceto share resources and jointly plan anddeliver particular services.

Integration involves a complete mergingo services to orm a new entity.

Horwath & Morrison (2007) describe theintegrated model as ollows:

Integrated services are characterised

by a unifed management system,pooled unds, common governance,

whole systems approach to training,

inormation and fnance, single

assessment and shared targets..

Partners have a shared responsibility or

achieving the service goals through joint

commissioning, shared prioritization,

service planning and auditing. Joint

commissioning can be one o the

major levers or integration, service

change and improving the delivery o

childrens services .. Ultimately, jointcommissioning may lead to the merger

o one or more agencies, who give up

their individual identities or a shared

new identity.

These various orms o collaboration andintegration may take the orm o virtualservice integration or actual co-locatedintegration. Co-location o services is seento be desirable or two reasons: becauseit can promote closer working betweenthe services involved and because itmakes it easier or amilies to access arange o services (the idea o a one stopshop). However, while co-location oservices might seem like the ultimate goalo integration, it may not be desirable oreasible in all circumstances. For example,in rural or remote areas the co-location oservices might disadvantage those whocannot easily access the chosen location.What would work better or them is virtualservice integration while the services arenot co-located, they do operate as a single

entity with common protocols and servicephilosophies.


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Teamwork

Integrated services require proessionalsto work in teams, oten with members odierent disciplines. For those used toworking in traditional ways, multi-agencyteamwork can be dicult to achieve (Anninget. al., 2007). Dierent orms o teamworkhave been identied (Anning et al., 2006;Briggs, 1997; Chandler, 2006; Watson et al.,2002; Watson et al., 2000). The our ormso teamwork identied by Briggs (1997) arerepresentative:

Unidisciplinary teamwork: oneproessional or one proessional

discipline attempts to serve all the needso the amily and child.

Multidisciplinary teamwork: severalproessionals or proessional disciplineswork in parallel to meet the needs o thechild and amily, with limited interactionand exchange o inormation andexpertise.

Interdisciplinary teamwork: severalproessionals or proessional disciplinescoordinate their services to the childand amily, but with limited crossing odisciplinary boundaries.

Transdisciplinary teamwork: severalproessionals or proessional disciplinesprovide an integrated service to the childand amily, with one proessional actingas a conduit o services or the team.

In transdisciplinary teamwork, all teammembers have to expand their traditionalroles. This involves a sharing and exchangeo certain roles and responsibilities, as well

as a sharing o inormation and training.Team members continue to be recognisedas the authority and resource or their ownprimary discipline.

Watson and colleagues (2000, 2002)suggest that transdisciplinary workingwould be rated most highly by amilies,but as yet there is no evidence to show

how or to what extent these models areimplemented in practice and what eectsthey have on outcomes or children andamilies. Transdisciplinary teamwork isthe preerred model in early childhoodintervention services (Davies et al., 2006;Kilgo et al., 2003; McWilliam, 2000;Woodru and Shelton, 2006). Best practiceguidelines or transdisciplinary teamworkhave been developed by the US Councilor Exceptional Childrens Division o EarlyChildhood (McWilliam, 2000).

Two other teamwork models that are worthnoting are thekey worker model (Drennanet al., 1997; Mukherjee et al., 1999; Sloperet al., 2006) and the Team Around the Childmodel (Davies, 2007; Limbrick, 2004, 2007;Siraj-Blatchord et al., 2007).

Conclusions

Eorts to improve outcomes or childrenand amilies must involve a wide range

o actions and interventions; no singleintervention can hope to achievesustainable improvements on its own.

Action is needed on three rontssimultaneously: building more supportivecommunities, creating a bettercoordinated and more eective servicesystem, and improving the interacebetween communities and services.

For integrated service delivery tobecome a standard eature o the servicesystem, there needs to be integration

o policies, planning and unding atnational, state and regional levels. Atthe regional or local area level, someorm o early years partnership to guidethe development o integrated services


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is needed, preerably with a person oragency acting as broker or acilitator.

In orming such early years partnerships,

there are two key issues to consider:how to ensure that all relevant servicesare involved, and how to link themainstream or universal services withthe various specialist services.

The existing service system o universal,targeted and treatment services needsto be recongured as an integrated andtiered system o secondary and tertiaryservices, built upon a strong base ouniversal and primary services.


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September 2010

. Existing models o service integration

International models

No country has yet succeeded in integratingall the services that children and amiliesmight need (eg. child welare, child health,child care and education, amily support,amily therapy, mental health, maternity,alcohol abuse, support or the unemployedetc.). However, there have been somenotable eorts to integrate some o theseservices, including Sure Start in the UK andthe Toronto First Duty program in Canada.

Sure Start has been described asthe most ambitious early interventionprogram in the world (Katz & Valentine,

2007). It is the rst large-scalecomprehensive community initiativeto be unded by a central government,and the ongoing evolution o thisprogram highlights a key issue acedby early years programs around theworld: how early intervention servicescan develop rom a series o isolatedand oten short-term programs intoa range o services which are asmainstream as schools or hospitals(Katz & Valentine, 2007). Melhuish et

al., (2010) note that the investment inSure Start utterly transormed early-yearservices while representing a relativelysmall contribution rom the perspectiveo treasuryjust 0.05% o publicexpenditure. In its latest incarnation,Sure Start Childrens Centres are placeswhere children under ve years oldand their amilies can receive seamlessholistic integrated services andinormation, and where they can accesshelp rom multi-disciplinary teams oproessionals. The UK Government is

committed to delivering a Sure StartChildrens Centre or every community by2010. Evaluations have been conductedby the National Evaluation o Sure Startteam (Anning et al., 2007; National

Evaluation o Sure Start, 2008) andsummarised by Melhuish et al. (2010)and Schneider et al. (2008).(http://www.dcs.gov.uk/

everychildmatters/about/surestart/surestart/)

Toronto First Duty is a Canadianmodel that was designed to build auniversal platorm to improve childrensdevelopment and societal outcomes. Itdid this by creating a service deliverysystem that provides a seamless blend ointegrated early learning, care, services,and supports, or all young children andtheir amilies in dened communities.

This model has been well evaluated andprovides a number o valuable indicatorsregarding the conditions needed or suchmodels to operate eectively (Corter etal., 2006, 2007, 2009).(www.toronto.ca/rstduty)

Australian models

National level

At the national level there has been a muchgreater ocus on early childhood issues

and services in recent years. The ocus othe current Federal Governments eortsin this area has been its National EarlyChildhood Development Strategy and thevarious National Partnership Agreementsreached with the Council o AustralianGovernments. Both the level o activityand the degree o agreement reached areunprecedented. However, there is stillno true whole-o-government planningmechanism at the national level, and theEarly Childhood Development Strategy itsellooks more like a collection o initiatives

that are praiseworthy in their own right butare not yet driven by an overall vision o atruly universal, inclusive and comprehensivesystem (Helyar et al., 2009).


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One ederal department that has promoteda local partnership approach to planningand service delivery is the Department oFamilies, Housing, Community Services and

Indigenous Aairs (FaHCSIA) through itsCommunities or Children initiative.

Communities or Children.Communities or Children is part o theFaHSCIAs Family Support Programwhich provides prevention and earlyintervention programs to amilies withchildren up to 12 years, who are atrisk o disadvantage and who remaindisconnected rom childhood services.O the 45 current sites unded under

the Program, eleven are located in NewSouth Wales and eight in Queensland.A local non-government organisation(Facilitating Partner) in each siteacts as broker in engaging smallerlocal organisations to deliver a rangeo activities in their communities.Evaluations o the program rom 2004-09 (Edwards et al., 2009; Muir et al.,2009) indicate that the Communities orChildren program has been successulin increasing service coordination andcollaboration, and that there were smallbut positive fow-on benets or amilies,children and communities. However,without ongoing unding, it is unlikelythat these service coordination programsor the benets gained rom them will besustainable.

State and regional levels

At the state level, some states (eg. SouthAustralia, Victoria, Queensland) haveaddressed the need to integrate servicesby consolidating early years services into

single departments. Several states havealso established senior interdepartmentalcommittees to coordinate planning andpolicy or early childhood services.

At the regional level, there are somewell-established strategies or creatingpartnerships that have been shown to beeective in promoting integrated service

planning and delivery. These includeNew South Wales Families NSW and itsSchools as Community Centres program,and Victorias Best Start and Primary CarePartnerships models.

Families NSW. This service coordinationprogram commenced in 1998 underthe title Families First and was agroundbreaking attempt to integrateplanning at a whole-o-government level.Implementation evaluations o Families

NSW have been conducted by the SocialPolicy Research Centre at the Universityo New South Wales (Fisher et al., 2006;Valentine et al., 2007). These showedthat the initiative was slow to get goingin some areas, and planning oten tooklonger than anticipated. Ultimately,however, the program was judged tohave made signicant gains towardsdeveloping structures and processes tosupport and extend the service networksystem that is coordinated and ocusedon prevention and early interventionsupport or children and amilies(Fisher et al., 2006, p. 19). Subsequentchanges in auspicing and unctioning oFamilies NSW appear to have reducedits eectiveness. It now unctions as away o coordinating government servicesand allocating government undingaccording to government priorities, anddoes not involve the non-governmentsector or consumer representation inthe initial high level planning. Whilethe importance o partnerships and

collaboration is acknowledged, thisappears to mean coordinated planningrather than integrated service delivery.While there is the option o unding beingused or service coordination, most


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unding is allocated or programs. Theevaluation processes in place ocus onthe ecacy o individual programs inimproving indicators, not on improving

the conditions under which amilies areraising young children or on the ecacyo integrated service delivery.

Schools as Community Centres.One o the initiatives operating underthe auspice o Families NSW is theSchools as Community Centres (SaCC)program. These support amilies withyoung children birth to eight years witha particular ocus on the years priorto school entry. Each SaCC project

responds to the needs o local amilieswith children by providing a range oactivities such as supported playgroups,transition to school, early literacyprograms, health and nutrition initiativesand parenting programs. In 2008 acrossNSW there were 51 SaCC projects.They are delivered in partnership withamilies, communities, schools and thehuman services agencies. Local SaCCacilitators, schools and interagencypartners plan collaborative initiativesto develop capacity in young childrenbirth to eight years, amilies and localcommunities.

Best Start. Commencing in 2001,the Best Start initiative in Victoriasupports communities, parents andservice providers to improve universalearly years services so they areresponsive to local needs. It has astrong emphasis on prevention and earlyintervention and is based on buildinglocal partnerships. These partnerships

include representatives o localparents, providers o services or youngchildren and their amilies, the tiers ogovernment, and other key groups whoare involved in, and can impact upon,

the day-to-day lives o young childrenand their amilies within a community.There are 30 Best Start projectsites across the state, six ocusing

specically on working with Aboriginalcommunities. Evaluations indicate thatthese partnerships have been eectivein promoting better service coordinationand joint strategic planning (Raban et al.,2006).

Primary Care Partnerships. Anotherwell-established service coordinationstrategy is Victorias Primary CarePartnership (PCP) model. Introducedin 2001, PCPs are designed to improve

coordination among health services in acatchment and thereby improve healthoutcomes. Altogether, there are over 800agencies that have come together in 31PCPs across Victoria. Evaluations o thisstrategy have shown that it is successulin promoting signicant integration withinthe primary health care system and thishas resulted in improved coordination oservices and more positive experiencesor consumers with the health system(Australian Institute or Primary Care, 2003,2005; KPMG, 2005; Walker et al., 2007).

Direct service level

At theagency or direct service level, mostintegration initiatives have taken the ormo establishing one stop shop child andamily centres. Integrated childrens centreshave been or are in the process o beingestablished in South Australia (20 centres),Victoria (98), Tasmania (11), and Queensland(4). These vary in what services are includedand how ully integrated the services are.

Queensland Early Years Centres.TBS is the lead agency in two oQueenslands Early Years Centres.Strategies or integration include apartnership model which involves


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unding partner agencies to appointa sta member to the centresmultidisciplinary team. Another strategyis the development o a three tiered

governance model that includes astrategic governance group with seniorlevel representatives rom governmentand non-government agencies; a localadvisory group involving representativesrom local government and non-government agencies who have directinvolvement with the Early Years Centre(e.g. regional director o maternal andchild health; local school principle) and aconsumer reerence group.

The service model includes a rangeo universal and targeted health, earlychildhood education and care, andamily support services, as well as sotentry outreach programs includingmobile playgroups and communityengagement activities. The modelincludes specialist pediatric healthservices as well as amily preservationand reunication services.

Less work has been done on developingtiered service systems that strengthenthe relationships between specialist andmainstream services. However, there aresome examples o innovative programsthat seek to provide assertive outreach orsot entry points or vulnerable or hard toengage amilies. These include:

Yummy Ca. Funded through TheBenevolent Societys Communitiesor Children program, Yummy Ca isa community ca run by the YWCAwhich operates as a social enterprise.

It is located right in the centre odisadvantaged and more afuent areasso it is well positioned to allow dierentcommunities to mix. The ca oers lowcost healthy ood, a space or children to

play, and a venue or other Communitiesor Children projects to run courses andworkshops. The ca also provides aspace or amilies to meet and connect.

The ca environment encouragesparticipation because it is inormal andamilies need not eel intimidated. Thesetting is also appealing as it oerschildcare, and a sae play area orchildren.

SDN Family Resource Centre. Fundedthrough FaHCSIAs Local Answersprogram, the Family Resource Centreprovides inormation, advice andsupport or parents with young children

aged zeroeight in Sydneys south-west (SDN Childrens Services, 2009).Built on a history o service deliveryand close working relationships withcommunity partners in the area, andutilising a previously existing ResourceCentre (Toy Library) as a oundation,the Centre responds to locally identiedneeds by providing a non-targeted,non-stigmatising sot entry point asa base on which to build layers otrans-disciplinary support or amilies.The Centre complements and ullyintegrates with SDN Resource Centreand other services in the local network tocontribute to the provision o inclusive,comprehensive services or children andamilies. As such, SDN Family ResourceCentre represents an integrated modelin action. The Centres services arehierarchically arranged. At the primary oruniversal level, and open to all memberso the community, the Centre contributesa qualifed early childhood education

teacher to the sta o the existing

childrens Resource Centre (Toy Library).At the targeted or secondary level, theCentre oers Stay and Playsessions(acilitated playgroups) where parentsand carers ocus on playing with children


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in a quality play environment, supportedby the early childhood education teacherand a amily resource worker (socialworker). Also at the secondary level are

Parent Groups, oered in partnershipwith Relationships Australia, that provideopportunities or parents to cometogether to ocus on issues o concernor to access new inormation, in thecompany o sta with whom they havea relationship and who they can trust. Atthe highest or tertiary level o intervention,Individual Family Support delivered bya trans disciplinary team oers intense,individualised, intervention or amilieswith the wide range o challenges that

some parents ace.

Practitioner level

At thepractitioner or teamwork level,relatively little work has been reported onhow to build integrated interdisciplinary ortransdisciplinary teams.

Conclusions

From this review we can see that thereare no Australian initiatives that matchthe scale o some o the overseasmodels. The Australian GovernmentsEarly Childhood Development strategy,despite having much to recommend it,does not yet match the breadth o visiono the UKs Every Child Matters policyramework or the scope o the Sure Startprogram. At the state level, no stategovernment has yet articulated a visiono a ully integrated service system asoutlined in this paper.

Nevertheless, there is a widespreadrecognition that services need to becomebetter integrated, and various nationaland state policies and unding initiativeshave ocused on this goal. As a result,there has been a signicant increasein on-the-ground eorts to integrateservices.


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. Improved service integration:

what we have learned

Governments throughout the developedworld have moved towards integrating earlychildhood services. Initially they have doneso on the basis o a strong rationale rather

than strong evidence. Nevertheless, there isemerging evidence that initiatives to promotegreater integration o services can besuccessul under the right conditions. Well-integrated early childhood services requirethe development o integrated policies andpractices at all levels: whole-o-government,regional, service, and team level. However,it is apparent that, whatever the level ointegration, successul collaborations arechallenging to achieve and sustain withoutongoing support and investment.

Demonstrating that improved collaborationbetween proessionals and greaterintegration o services have a positiveimpact on children and amilies is dicult,because it is neither easible nor ethicalto randomly allocate amilies to joinedup and not joined up services and thencompare outcomes (Valentine et al., 2007).Nevertheless, while research evidence isstill limited, existing evidence suggeststhat integrated service delivery can havepositive benets or children, amilies andproessionals. Reviews o the literature oncollaboration and partnerships (Centre orCommunity Child Health, 2008; Fine et al.,2005; Lord et al., 2008; Siraj-Blatchord &Siraj-Blatchord, 2009; Valentine et al., 2007)suggest the ollowing conclusions:

While partnership working is widelyassumed to be a good thing, it can bedicult to put into practice successully- it requires careul planning, commitmentand enthusiasm on the part o partners,

the overcoming o organisational,structural and cultural barriers and thedevelopment o new skills and ways oworking (Percy-Smith, 2005, 2006).

The evidence suggests that thereis conusion among policy makers,service providers and consumers asto what integrated service delivery

is intended to achieve and what itmeans in practice (Siraj-Blatchord &Siraj-Blatchord, 2009). The currentguidance and terminology associatedwith integrated service provision needsgreater clarity.

The quality rather than the type ointegration is what matters in terms oimproving outcomes (Siraj-Blatchord& Siraj-Blatchord, 2009). Thereore, itis important to develop a clear, shared

understanding o what is meant byquality in integrated delivery o earlyyears services and to ensure thatservices adopt agreed quality standards.

Eective integrated working is principallybased on the personal relationshipsthat are established between workers.While these may be eective in theshort run, they may not be sustainable(Department or Children, Schools andFamilies, 2007).

Although it is not possible to use

the most rigorous research methodsto measure outcomes o integratedservices (Valentine et al., 2007), thereis indirect evidence that multi-agencycoordination initiatives can have benetsor children, amilies and proessionals.The evaluations o Sure Start in theUK (Melhuish et al., 2010; NationalEvaluation o Sure Start, 2008) oundsome modest benets or childrenliving in areas where a Sure Start Local

Program (usually involving an integratedchild and amily service hub) operatedwhen compared with children livingin similar areas that did not have aservice hub. The children showed better


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social development, exhibiting morepositive social behaviour and greaterindependence/sel-regulation than theirnon-SSLP counterparts. Evaluations o

the Toronto First Duty program (Corteret al., 2006; Toronto First Duty, 2008)also ound benets or the children (theybeneted socially and developed pre-academic skills.

Evidence that amilies benet comesrom a range o studies (Dunst & Bruder,2002; Corter et al., 2006; Harbin et al.,2000; Harbin & West, 1998a, 1998b;McGregor et al., 2003; Melhuish etal., 2010; National Audit Oce, 2006;

National Evaluation o Sure Start, 2008;Robson, 2006). Positive outcomesinclude better fow o resources,supports, and services, parentsatisaction with provision o neededservices, improved well-being andquality o lie, and reducing the impact osocial isolation. Service integration onlybenets children and amilies i it resultsin higher quality intervention (Valentineet al., 2007).

The quality o care services or childrenis the central and most consistent actorthat determines the eects o thoseservices on children. There is evidencethat the program quality is higherin integrated programs than in non-integrated programs (Toronto First Duty,2008).

There is also evidence that integratedservice models have benets or serviceproviders (Allen et al., 2002; Corter etal., 2006; National Audit Oce, 2006;

Schrapel, 2004; Toronto First Duty,2008; Young et al., 2006) and encouragecollaborative practice between serviceproviders.

As Fine et al. (2005) note,

.it is evident that there is no science

o administration, or even a consensus

about the state o the art that couldprovide a ail sae blueprint or the

reorm o ragmented patterns o service

delivery. There is however, a sufcient

degree o agreement amongst experts

that, properly applied, integration

initiatives can bring considerable benefts

to those who depend on the assistance

provided.

Another key nding is that serviceintegration only benets children and

amilies i it results in higher qualityintervention (Katz & Valentine, 2007).Children and amilies are changed byrelationships with people who work directlywith them, not by the policies or networksor agreements that proessionals reach.Unless the policies and practices that aredesigned to promote service integration andcollaboration produce positive changes inthe quality o the services that children andamilies receive, they cannot be expected toshow positive changes as a result.

This does not mean that other types odirect interventions such as home-visitingor parent education would necessarilybe more eective. As Katz & Valentine(2007) have pointed out, these ocus onindividual children and amilies rather thanwhole communities, and are too costly toimplement aithully on a national scale.Integrated service systems have impactsthat are more subtle than the well-knownorms o evidence-based intervention, butthe eects are potentially much more long-

lasting and ar-reaching.


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Factors that promote or hinder

service integration

Overall, there is considerably more evidenceregarding the process o multi-agencyworking than on the outcomes o suchcollaborations (Sloper, 2004). These processstudies have produced consistent ndingson the actors that promote or hinder multi-agency collaboration.

Reviews o co-ordinated multi-agencyservice delivery (Atkinson et al., 2005;McGregor et al., 2003; Siraj-Blatchord& Siraj-Blatchord, 2009; Sloper, 2004;Valentine et al., 2007) have identied the

ollowingbarriers to successful multi-agency collaboration:

top-down decision making

too many players and initiatives

lack o clarity regarding roles andresponsibilities

dierences in organisational aims, lack oconsensus on aims or overambitious aims

lack o commitment and support rom

senior management poor communication and inormation

sharing

inadequate resources and lack o jointbudgets

lack o ongoing training

lack o leadership

lack o time or joint working and training

negative proessional stereotypes andlack o trust and understanding between

individuals and agencies

constant reorganisation and requentsta turnover

lack o qualied sta

nancial uncertainties

dierent proessional ideologies andagency cultures.

Reviews o integrated service delivery(Atkinson et al., 2005; Johnson et al.,2003; Pope & Lewis, 2008; Siraj-Blatchord& Siraj-Blatchord, 2009; Sloper, 2004;Toronto First Duty, 2008; Valentine et al,2007) have identied the ollowing factorsthat promote successful multi-agency

collaboration:

commitment or willingness to be involved

understanding roles and responsibilities

having common aims and objectives

eective communication and inormationsharing

strong leadership and a multi-agencysteering or management group

understanding the culture ocollaborating agencies

providing adequate resources orcollaboration

participatory planning processes involving the relevant sta and agencies

sharing and access to unding andresources

joint training and team building

appropriate support and supervision orsta.

In addition to these research ndings, therehave been a number o lessons learned

rom working with community-basedpartnerships about the challenges servicesace when seeking to build strongerlinkages between services. Based onextensive experience in working with such


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partnerships, the Centre or CommunityChild Health has identied the ollowinglessons learned:

partnerships take time to becomeeective this is because it takes timeto build trust between the individualsand organisations involved

local leadership is critical whenleadership was lacking, partnershipswere weak

local acilitation is also important thereneeds to be someone who is paid toacilitate and support the partnership

early years partnerships have diculty

shiting rom a service-based approachto an outcomes-based approach - therst impulse o services when oeredadditional money is to want to do moreo the same

early years partnerships also havediculty developing coherent actionplans they need guidance in identiyinggeneral strategies and interventions thatwill lead to better outcomes

all partnerships eventually reach a

sticking point regarding sustainability they need to develop need newgovernance structures to ormalise thepartnership arrangements

another sticking point is disseminatingthe vision and action plan

selling the partnership / integratedapproach up (to the managers o thevarious agencies and departments thatthey worked or), out (to colleaguesand other agencies not directly involvedin the partnership), and down (toconsumers and the wider community).

These last two points illustrate a distinctionmade by Foster-Fishman et al. (2007)between rst-order and second-orderchange. First-order change involves making

sure things are done right by makingincremental improvements within existingmodes o practice. Second-order or radicalchange involves a paradigm shit in how aproblem is perceived and what strategiesare used to address it; how things aredone is undamentally altered. The stickingpoints that inevitably seem to occur whencommunity-based partnership try tocreate integrated service systems refectthe diculty o moving beyond rst-orderchange and adopting a radically dierent

model o working.

Conclusions

Establishing ully integrated servicesystems is a challenging task thatinvolves major changes in the way thatservices and proessionals operate.Despite the diculties involved, thereis a strong rationale or seeking greaterintegration and clear indications othe conditions that need to be met or

integration to be achieved. The ull adoption o integrated service

delivery models will ultimately requirechanges to unding arrangements,position descriptions, and recruitmentand ongoing training practices. All thoseinvolved, whether as managers or directservice providers, will be required toexpand their roles and will need specictraining and ongoing support to do so.


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. Priorities and recommendations

From the analysis presented in this paper,it is apparent that current policies andservices have not yet adjusted sucientlyto the changed circumstances in which

amilies are raising young children to ensurebest outcomes or children. Priorities oraction include the ollowing.

Priorities

Regarding developing policies andrameworks to support integrated servicesystems, the main priorities are to:

develop more comprehensive nationaland state policy rameworks to support

the creation o truly universal andinclusive service systems or youngchildren and their amilies

build a clearer understanding o howto improve the conditions under whichamilies are raising young children andhow to support amilies more eectivelyin their child-rearing roles.

Regarding promoting integrated servicesystems, the main priorities are to:

strengthen universal services anddevelop models embedding secondaryand tertiary services into mainstreamservices

build early years partnerships in everyregion to guide the development ointegrated service systems and practices

develop governance and unding modelsto ensure the sustainability o suchpartnerships

dene the role o broker or acilitatoror these early years partnerships anddevelop ways o unding and supportingthese positions

develop a range o sot and hardentry points that provide amilies withsimplied access to a wide range oservices.

Regarding lling gaps in services, the mainpriorities are to:

build outreach services to engagevulnerable and marginalised amilies andto link them more eectively with otheramilies and with appropriate services

develop a wider range o interventionsthat help amilies support their childrenslearning and development moreeectively.

In the light o these priorities, the ollowingrecommendations address actions that non-government agencies (such as TBS) andothers can take to move towards greaterintegration o the various elements osupport and/or services needed by childrenand their amilies.

Recommendations

National level actions

At the national policy level, non-governmentagencies can play an advocacy role,either individually or collectively. Themain areas that could be targeted are theneed or urther work on the national earlydevelopment agenda (which does not yetprovide a strong enough conceptual baseon which to build eective integratedservice systems) and the need to improvethe conditions under which amilies areraising young children (which have notyet been clearly articulated, nor has the

need to improve these conditions beenrecognised as the most important target ointervention).


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Recommendation: the developmento a national early childhood agendathat is truly universal, inclusive andcomprehensive.

Recommendation: the development opolicies and strategies that will improvethe core conditions needed by parentsto raise their children as they (and we)would wish.

There are some other national initiatives thatoer urther possibilities or action. Theseinclude the national roll-out o the AustralianEarly Development Index, the Communitiesor Children initiative, the commitment to

Universal Access strategy or preschooleducation, and the unding o Early Learningand Care Centres.

Australian Early Development Index

(AEDI). The AEDI provides aggregateinormation on the unctioning o childrenin their rst year at school or every localcommunity (suburb or small area) in thecountry. The unctioning o the childrenrefects the extent to which the amiliesand services in a given district providedthe children with the experiences andopportunities that would enable them totake advantage o the social and learningopportunities that schools provide. Fullresults on the rst national administrationo the AEDI were released in December2009, and will be ollowed up by urtheranalyses o small com

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