Evidence Centre Seminar: August 2022

SONIA SHARP: Just a little bit of background. Some of you have connected with us as we've been working with Oranga Tamariki over the last couple of years.  We started a couple of years ago, initially, in the early days of COVID, looking around the world at what was happening for children and young people and families as we entered the pandemic.  Through other work that we've done, we've been continuing to connect globally and locally.  Then, more recently, we've gone back to some of those communities and contexts to look at, two/three years on, what we have learnt further, and in particular thinking about those children and young people with high and complex needs.  So what we're going to do with you today is share with you some of those insights, and because we're a lovely, beautifully sized group, hopefully engage with you in the things that you're most interested in learning about.

This is our general agenda.  Welcome and introductions: myself, Georgie and Alicia are the team from EY who have done that.  We're deep in the government practice and have worked for many years with children and young people.  My background is in the UK and Australia, where I've led services for children and young people across social care, health, education and justice.  I've dedicated my life to trying to make the world a better place for children.  Georgie, did you want to quickly introduce yourself?

GEORGINA GATES: Thanks, Sonia, and hello, everyone, I am Georgie Gates.  I'm actually joining you today from the lands of the Ngunnawal people, which is located in the Australian Capital Territory.  My background is in service design and workforce design and development for human services workforces.  I spend a lot of my time working with different agencies and service providers on the way that they can strengthen their approaches to supporting children and families, and also enabling their workforce.  Very pleased to be with you here today. 

SONIA SHARP: And Alicia?

ALICIA: Hi, everyone, I'm Alicia and I'm a consultant in EY's workforce advisory practice.  I've worked with Georgie and Sonia on a number of projects now in the child and family services sector and I'm really happy to be here with you all today, so thank you.

SONIA SHARP: Fantastic, great.  So the shape for the day is to really think about the key insights from research, and we've pushed them into two parts: first of all, thinking about transition through disruption, so how do we live with this at its peak and most challenging times, through to then how do we recover and continuously improve.  Also, most importantly, what are the really promising practices that have emerged through the reinvention that people have had to do across child and family services and child protection services that we want to keep and build on further?  Then, as Beth mentioned, we'll have time for Q&A. 

Just to give you a kind of quick overview of the areas that we're going to touch on before we deep-dive, our research looked into how we might maintain care and protection, how we can secure workforce and business continuity, how we can collaborate across the sector and services, how COVID-19 works through in different communities, and then, as I mentioned earlier, a focus particularly on practical strategies for the care and protection of children with high and complex needs throughout the pandemic.  As well as the overall scan of what's going on, those are some of the deep-dive areas that we focused on in this recent piece of work.

Some of the emerging themes that have come through have been -- on the left-hand side here, in terms of the key insights about how do we effectively transition disruption, we've seen some really promising work about the evolution of digital social work, so social workers using technology in new and different ways, some of which have enabled not only better connection with families and children and young people during COVID but also have opened up new opportunities for working collaboratively with families.  We've also seen some extraordinary things around data sharing and analytics, better predictive analytics, better targeting through use of data and more joined-up work and integrated work across different services to keep children safe.  We've also heard a lot about community-led responses that are particularly effective for communities across cultures, where there's an incredible role for communities to lead and be genuine partners in managing the local response.  We've also seen the emergence of genuine collaboration and peer support in very different ways across different agencies and services that are crucial when dealing with complex needs cases. 

In terms of the recovery and improvement on previous best, we've heard a lot about the emergence of more agile forms of governance to actually have an on-the-balcony view of the patterns and trends and how things are playing out, so that resources can be mobilised quickly or reallocated swiftly.  We've heard about an adaptive and more systematic approach to collaboration, particularly across the child and family services sector and the social services sector.  We've also heard and seen the importance of continuing to monitor, predict and act upon the medium to long-term impacts on children and families that have been seeded during the pandemic, and some of those are still emerging and will continue to emerge as we go forward.  We've also seen the importance of the ignition of sector-wide recovery and child-centric initiatives to streamlining services. 

We're going to give you a bit of a dive into each of those eight key areas because we would say these are probably some of the most interesting insights for us, but I will emphasise that nobody's found the perfect way of working through this.  We've all been incredibly creative, just had to use what we have to hand, and I must say a big hats off to everybody in the social work and caring professions, human services sector and health sector because we have seen the most extraordinary resilience and creativity.  Many children are safer and have stayed safe and well because of extraordinary efforts by people around the world and across New Zealand as well, so you mustn't ever forget that extraordinary supports, resilience and creativity that we've seen. 

Some of the patterns and trends you'll be familiar with but it's just worth recapping on some of the impacts that we've seen.  The impacts of the pandemic on children have been significant.  Only this week - and some of you may have read this - the World Bank published a report.  They've been monitoring for some time the literacy levels of ten-year-olds around the world and what they found was in 2019, just heading into the pandemic, about 50% of ten-year-olds around the world had reasonable literacy levels, literacy levels to be able to navigate their education system, and had the foundations to do really well in the future.  Now that number has reduced to 30% just in the last couple of years. 

In some countries in the last two years, children have only been able to access 20% of the educational experience that they normally would.  Around the world, 463 million children couldn't access remote learning in 2020 globally, and we know that we've been very dependent on that.  370 million might've missed nutritious school meals and so their nutrition has dropped off significantly because of schools not being open.  You'll see that this is a really big theme running throughout.  Keeping schools open, we're beginning to understand how very important that is.  We've always known that schools provide many supports for children, particularly thinking about protective factors - school attendance and engagement is a common protective factor - and what we've seen first-hand is what happens when we take this away. 

Really sombrely and sadly, just over 1.5 million children around the world have experienced the death of a primary or secondary caregiver.  Many children have lost their grandparents, all of their grandparents, and many have lost a parent, in particular fathers.  We've heard about the Great Resignation but many people are talking about the Great Orphaning.  Many children have been orphaned through the pandemic.  We've seen a 20% increase in domestic violence calls to the New Zealand Women's Refuge during initial lockdowns - that figure has been 40% to 50% globally - and four in ten Australian high school students reported severe emotional distress due to the pandemic.  We've also, again, in our research, heard about a tripling of parents reporting mental health issues and distress.

This pandemic has had immediate and far-reaching impacts.  As we've already mentioned, we won't really understand the impacts of some of them for some time to come, but there's very few people who have not been impacted in some way or other, and many people quite significantly and severely. 

We have seen child-level factors.  We've seen data that indicates poorer mental health for children, poorer child health and development outcomes, and definitely poorer academic achievement.  We've seen at a family level poorer parental mental health, as I mentioned, a tripling of parental mental health issues being reported in Australia.  We've definitely seen increased stress and economic burden.  We've seen an increase in reports of abuse and neglect.  At a service level we've seen, as I mentioned, the impact of school closures.   We've seen reduced access to healthcare.  Certainly here in Australia our health services are genuinely concerned because so much routine healthcare has had to go on hold, including elective surgery.  We've seen a drop in the level of screening for health issues.  We know, again, there's going to be some long-term impacts there.  But we've also seen better learning, connection and care through technology, so the silver lining is the technological solutions and the technological transformation that we've been on, and also some really strong community impacts.  We've seen an increase in volunteering and people being able to be active within their local community in a way that they hadn't.  We've seen people returning to the workforce that had previously retired.  It's not all doom and gloom, but certainly there are some impacts that we all need to be conscious of, and they're global as well.  You see these same themes emerging around the world.

Let's move on then to some of the insights that we've seen in terms of effectively transitioning through disruption, and I'm going to hand over to Georgie now. 

GEORGINA GATES: Thank you, Sonia.  We'll spend just a little bit of time talking to some of the findings from our research on the way in which service systems and service providers have effectively transitioned through disruption.  Having looked at the way that services were adapting to the pandemic earlier on in 2020, we've now really taken a look at the impacts and what have been some of the key success factors in navigating through the pandemic now that we have emerged into 2022.  Despite many challenges, many services around the world, and agencies, have done an outstanding job in navigating through the pandemic. 

The first area that we have seen as a strongly emerging theme has been the evolution of digital social work and the leveraging of collaboration mechanisms to drive change, transformation and adaptability across the services and service system for children and families.  Throughout the pandemic and particularly now at the stage that we are at today, we have seen that service systems have moved from quite a traditional mode of digital engagement where digital technologies have been utilised in isolated circumstances to support engagement with children and young people.  In the early stages of the pandemic, these were certainly utilised to understand and work with children and young people and were seen to support engagement in a very different way but were recognised to not provide a full sensory experience of the child and their stage of development or their needs.  Also, I think it did provide some engagement with the family environment but was recognised to be quite an incomplete experience. 

We have now moved quite successfully to a more hybrid way of working in many service systems around the world.  The shift to a digital and hybrid mode of social work has really enabled social workers around the world to work in quite a different way, to be able to understand, interpret and identify risks to the families and children and young people through the use of digital technologies, and move to a more sophisticated way of engaging with children and young people using digital technologies.  I think it has been recognised through the research that it has also supported social workers to manage their own wellbeing, manage risks to themselves, and also be able to utilise technology in a different way to collaborate around reflective practice and other mechanisms that support management of vicarious trauma and other emerging risks to social workers in their practice. 

Now we're moving to an environment where, having through the pandemic demonstrated the use of digital technologies in quite an innovative and adaptive way, many of the services systems that we have investigated are making quite a significant shift and looking at ways in which digital technologies can be utilised in a much more sophisticated way, both in the way that it can continue to be used as a mechanism of engaging with children and young people, but also in the way that it can be considered to enable social workers in their practice through a range of technologies that support day-to-day practice and collaboration across the service system, and with stakeholders, from a practice and operational perspective. 

In terms of collaboration, we are seeing a shift along a continuum in the way that technologies are being used to support collaboration.  That's been underpinned by investment, by a range of support networks and by collaboration and adaptability.  Some service systems are starting to look towards the way they might need to transform and work differently into the future, and use technology in a way that can both support engagement with children and young people but also recognise that some of our traditional methods and approaches to workforce design need to be transformed into the future, when we consider the typical profile of demand across the service system and the range of constraints that practitioners are experiencing day-to-day in managing workload and demand. 

Another area that we did very much look at through our research was the way in which communications challenges and different challenges can be anticipated or have been anticipated by service systems in navigating COVID-19.  Each of these have been identified as factors that are increasingly important in navigating the indirect challenges that will continue to emerge as the impacts of COVID-19 continue to be felt and emerge across our population of children and young people. 

Firstly, workforce retention and development was highlighted as really critical.  This was a top factor for services and many of you will have recognised this through your own experiences in navigating the pandemic.  However, critically, at the moment we are seeing rates of attrition across different social work workforce segments where the stress and wellbeing impacts through the pandemic have had increasing effects, and we continue to see movement in workforces around the world which is putting pressure on an already stretched workforce.  This, I think, highlights that an investment in workforce development and retention is increasingly important going forward as service systems look to navigate through the social recovery and prepare for possible further increases in demand across the service system. 

Clearly, as well, sickness and associated absences continue to be a critical issue for many workforces.  We are seeing that as a result of the ongoing prevalence of COVID many workforces are experiencing up to 30% absence at any one point in time.  For some individuals, recovery from COVID can take quite some substantial period of time.  This is, again, putting an ongoing pressure on workforces around the world.  There is a real need to proactively look at and manage future planning around sickness levels across the workforce and build that into models for practice and workforce planning, as well as looking at the way in which the workforce can be utilised in a flexible way to cover demand and manage absences as well.  

In terms of some of the areas that have enabled the evolution, we have seen very much that throughout the pandemic service systems and service providers that were able to use data really effectively had a head start in being able to manage the service system.  Also, those that have been able to effectively manage and plan for demand have really seen quite a range of benefits in terms of being able to transition through the pandemic effectively.  These will continue to be critical areas as we see new and emerging areas of demand and need across our populations and communities, particularly when we think about vulnerable children and young people and some of the impacts and indirect impacts that Sonia spoke about.  Sonia, I'll hand back to you to talk to this one. 

SONIA SHARP: I was going to say that as well.  What we're seeing too, again with this emergence of digital social work including the data sharing and analytics, is the ability to target much more effectively.  Also what we're seeing, say, in New South Wales as one example, they've been able to put their internal case recording system onto a mobile app with lots of connectivity.  Social workers have really good voice-to-text abilities so they can upload their notes literally in real time, they can record and upload recordings, they can attach photographs, and also they can have access to all the assessment tools that they might want to use.  Then the recording can be uploaded instantaneously, and so, again, the availability of not just hard data but also qualitative information has been enhanced as well.  The other bit we're seeing is, again, a trend towards accelerating integration of data sources, so linked data sets, etc, so that we've not only got an enhancement in terms of predictive analytics - and of course yourselves in New Zealand are very much leaders in that area - but also just better-quality information sharing, as well as the reduction of administrative burden so that social workers can focus on face-to-face work and engagement. 

The final thing I'd just add here as well - and Georgie touched on it earlier - is that we're definitely seeing, particularly from young to middle teens, the ability to connect with their social worker or case manager by phone, by text or by app, which has meant an increase in children and young people reaching out themselves.  We've also seen in that particular age group a trend towards effective self-triaging as well, so some really promising practice in this area.

Just a couple of examples to share with you here.  Say, for example, in the US, several areas have been engaging in data-informed health equity analysis.  They’ve built a dynamic data model to support data-driven strategic decisions, so they can see at a glance where their most vulnerable populations are during COVID and they've put in an algorithm that picks up some key indicators - not always the case, as we know, but generally when you get a combination of certain indicators then it causes one to ask questions and look a little bit more closely - particularly looking at the communities that they know tend to be underserved medically, health-wise and educationally, so that they can really enhance vaccination efforts.  They've had some really big success there.  Also later on we'll give an example of using, again, a similar kind of algorithm to be able to predict where there may be outbreaks of COVID-19 in residential centres, Corrections institutions and schools as well as aged care and other facilities, with great effect.  They've now been able to, as a result of that, take very prompt action, which has led to a significant reduction in transmission rates, hospitalisations and deaths. 

Shall we move on then to thinking about community-led, culturally sensitive -- this kind of notion of community-based practice?  That's been another emergent theme.  What we're seeing is that there's been incredible success where communities themselves have been engaged in leading local responses.  What we've seen as the key features in these community-led responses is, first of all, self-determined governance, community-led collaboration, community-led service models and practice, and culturally tailored communications.  To give you a couple of examples, in Canada vaccine uptake was really accelerated through campaigns which were led by Indigenous leaders across their locality and Indigenous-led services.  That led to such an improvement and sense of trust that vaccination rates were very, very high.  We saw the same in Australia, where Aboriginal organisations such as First Peoples Disability Network actually mobilised their local workers to support communities so that critical support for people with disability could be maintained.  Again in Australia we saw relatively low levels of COVID-19 transmission in Aboriginal communities, again because of having a very strong Aboriginal-led response. 

The other element was also around peer support, service to service support.  What we saw, particularly when it comes to supporting children with very complex needs, is that where you had a really strong, integrated approach to support that spanned system, organisation, team and right through to the individual, then there was a much more effective response and a greater level of protection and engagement for those children and young people with high and complex needs. 

GEORGINA GATES: When we looked at the experiences of children and young people with high and complex needs throughout the pandemic and different aspects of responses that had been effective or had better supported the children and young people with particularly high and complex needs, we did see that there were a range of factors: both the peer support model and different models of collaboration across from an individual and team up to organisation and system level, as Sonia mentioned, but we also saw that quite tailored approaches to workforce and service continuity, governance and cross-sector collaboration were critical when it comes to children and young people with high and complex needs, particularly because they did experience, in many cases, elevated impacts from the pandemic. 

One of the examples that was quite illustrative on this particular point was in the United States, where they leveraged the community health workers really effectively to enable that peer support model from an individual and team up to service system level.  The community health workers played a peer support, a system navigator and connector role, working almost as a key worker but across a range of services to connect up the support model for children and young people with complex needs, bringing them together into a coordinated programme of support.  This pilot was run both throughout the pandemic and now still today, and has been found to have had really strong success in enabling effective responses to children and young people with high and complex needs. 

Some of the areas that were identified as really effective in the model were the deliberate focus on hiring and staff development in these roles, particularly looking at specific capabilities that were necessary in being able to bring together a range of diverse organisations and service providers, and also those that supported working with children and young people with high and complex needs in a really effective way, such as empathy.  There was specific training put in place for these workers that spanned health and other boundaries and really sought to train them well in a team-based model of care and relationship-based practice, and had that focus as well on emotional intelligence and empathy.  It did also look at how teams could be developed in an integrated way, looked at cross-disciplinary education and practice development that enabled practitioners to better understand their respective strengths and contribution to an integrated practice model, and really looked at how a health worker model could integrate effectively with other disciplines across the social work continuum. 

Then finally, it was very strongly supported from an organisational and leadership perspective.  Community partnerships, champions from a social work and clinical practice perspective, as well as the buy-in from leadership, could enable very strong efficacy across the model and really helped to achieve outcomes for vulnerable children and young people with high and complex needs.

SONIA SHARP: One of the things that we've seen as being critical in terms of recovery and continuous improvement is the benefits of what the World Economic Forum has described as "agile governance".  What we're seeing is that where you can bring multiple stakeholders together to understand the patterns and trends within an area - and that could be a country, it could be a region, it could be a local town, it could be a village - so that you can really bring people together -- and also multi-sectorial, so not just within the public sector but also thinking about local industries and other key bodies, who've got a vested interest in making sure that we thrive and flourish economically, socially, spiritually and physically.  Bringing those groups together to think really creatively about future solutions can accelerate and cut through to some more creative solutions in an accelerated way, so it's kind of like a fast-track through to doing some things that perhaps, if we think just as a single sector - say, for example, just within the public sector or NFPs, or just as a single service or agency - we wouldn't necessarily be able to leverage. 

What we've seen there is that agile governance strengthens interagency collaboration, it enables people to manage uncertainty more effectively, it strengthens cross-jurisdictional connection, it helps to cut through some of communication challenges we see, it accelerates the positive impact and opportunities of technology, and also demonstrates the benefits of people engaging in governance and system stewardship. 

Connected to that is the importance of adopting a more systemic approach to collaboration.  Here we looked particularly at the social service sector, and what we saw were six features that really stood out in terms of systemically strengthening collaboration and relationships between providers that might previously have been in competition.  Certainly developing a universal approach to care, leveraging stakeholders' knowledge and expertise to promote innovation, raise standards of performance and to enable a more integrated and holistic approach to the care and protection of children and young people.  We also saw that this systemic approach to collaboration really encouraged and facilitated greater resilience, strengthening bonds between service providers to enable a more resilient response.  It encouraged better commitment and engagement, lifted service standards, but also - in terms of thinking of some of the challenges of attraction and retention of workforce and the ability to have contingent workforces when we see large swathes of the workforce unable to engage - enabled contingency, led to greater efficiencies, was both replicable and sustainable, and also increased the scale and power so that we could reach more people and amplify impacts and results. 

Then, finally, what we also saw was a real emergence of sector-wide recovery and child-centric initiatives to streamline services, including those led by children and young people themselves.  One of the conversations that we had that really stuck in my mind was with one of the people who does a lot of work directly with children and young people, who said, "You know, this pandemic has had such a big impact on us, and what we've heard is a lot of adults talking to adults about us and not enough adults talking with us".  A greater focus on children and their needs and their outcomes, putting that first, but also the engagement of children and young people themselves.  Making sure that we're inclusive in our approach, building community trust, synchronising and collaborating with agencies to share learnings, policies and experience, and also taking time to pause and reflect so that those innovative practices, even though they might be emergent, can be amplified and extended. 

So that's, in a nutshell -- I know that we've moved very quickly so we have time for reflection and discussion now, but those are the key eight areas that have emerged as very strong features of global practice that seem to be widespread and really taking root, some of which are there to help transition disruption and some of those that are around recovery and continuous evolution. 

We'll pause there.  I can see that we have got a question which is around high and complex needs, but about how the high and complex needs children were identified and what were the criteria used to measure that level of complexity.  I see Heather has put in a response.  Georgie, did you want to cover that?

GEORGINA GATES: Yes, thank you.  That's a really good question and it's actually one that we delved into to quite some degree through our research, initially with a view to seeking to identify some common findings around the world of the ways in which children and young people with high and complex needs are identified and the criteria used to do so. 

One of the key findings from our research is that there is no one consistent way of identifying children and young people with high and complex needs or a common set of criteria.  We found that almost every jurisdiction and geography uses quite a different approach, with variability in what they define as high and complex needs, whether it is in terms of looking at different age and stage cohorts, looking at the breadth of need for that child and young person, whether that might be just purely about complexity of risk from a child safety perspective, or whether that's also around breadth in terms of mental health needs, disability and other factors, or presence of family violence within their home environment.  There are a whole range of factors and different threshold criteria that are used in every jurisdiction. 

One thing we did find, though, is that through the research and analysis there were, I suppose, not so much commonalities in the criteria and thresholds used to define that cohort, but there were commonalities in the findings on the way in which different service systems had responded to children and young people with high and complex needs.  I think they were some of the themes that I mentioned briefly before around the overall exacerbated impact for these cohorts throughout the pandemic, a need for a much more heightened response to these cohorts, and the use of data and analytics to identify and try to target different cohorts and respond proactively to cater to their needs. 

This I think we saw, particularly with some of the predictive models in the US.  Of course a set of predictive algorithms is never a perfect scenario but they do have a use in terms of being able to analyse and identify need across data sets.  Then also the way that more integrated and targeted responses were provided both in terms of maintaining service continuity and providing heightened levels of service, making sure that the workforce was adequately skilled and had the right continuity to support, and then also looking at the way in which governance and other things like that could adapt and cater to the needs of children and young people with high and complex needs.