The Family Partnership Model in practice in New South Wales: Working with families with complex needs to make a difference

The State of New South Wales in Australia has adopted the Family Partnership Model (FPM) developed by the Centre for Parent and Child Support in the UK as the preferred approach to child and family services. This case study shows how this approach to co-production works at a Residential Unit for families with young children provided by Karitane, an organisation providing a range of child and family services based in Carramar, Sydney.

The impetus for change came from recognition, shared across many countries, of the problems that arise from ‘traditional’ expert-led approaches within the health service sector. Expert-led approaches tend to focus on the development and communication of professionals’ expert knowledge, paying less attention to engaging and enabling clients or patients to be active partners in the health care process. As a consequence, families can be discouraged from engaging with services. They may be less likely to follow through on professional advice if they do not feel engaged, listened to and involved in decisions that affect their health and their daily lives.

Involving service users as active and knowledgeable participants, rather than passive consumers of child and family health services, aligns with an international policy focus calling for more co-productive and partnership-based approaches.

The FPM was developed at the Centre for Parent and Child Support in the UK, part of South London and Maudsley NHS Foundation Trust. It is an evidence-based approach built around a suite of professional training courses, with an associated set of training manuals. These enhance professionals’ skills in negotiation and communication, and provide professionals with a robust platform upon which to build co-production practices based on particular qualities of their relationship with clients, referred to in this context as a partnership. FPM involves a staged helping process, helper qualities, communication skills, ingredients of partnership, and wider service features. Further details are available via the CPCS website http://www.cpcs.org.uk/index.php?page=about-family-partnership-model.

Karitane one of several organisations providing services for families with young children across the state of New South Wales, Australia. It has embedded co-production practices under the rubric of the FPM in all its work.

Karitane’s aims reflect those of FPM and the NSW government in terms of supporting young citizens to break cycles of neglect and inequality. The Residential Unit supports families experiencing challenges in parenting children under four years of age. Families receive round-the-clock support during a single five-day stay. FPM helped to bring about services that actively involve parents in negotiating goals, making decisions, and assessing outcomes. Within the FPM, outcomes are identified as building capacity, problem anticipation and resolution, and resilience in families, rather than as short-term fixes to problems where professionals solve problems for families.

The FPM Foundation course was made available to many child and family health professionals across NSW. Professor Hilton Davis and Dr Crispin Day, the original developers of the FPM in the UK, developed strong links with many health services across Australia, delivering training directly. They now work in a consultative role as Australian organisations develop capacity to deliver FPM training themselves. The Foundation course is usually delivered in 5 full days or 10 half days spread over two or more months. It covers all aspects of the Model, including stages of the helping process, ingredients of partnership, helper qualities and skills, and makes use of role-play in which participants draw on their prior practical experience. There are currently no renewal requirements once training is completed, but the Model explicitly adopts the view that this training marks the beginning of a process, rather than a conclusion, and ongoing personal reflection, and support through clinical supervision are anticipated.

Karitane strongly encourages all clinical staff to complete this course, providing time away from primary duties as appropriate. FPM is spread horizontally across all clinical, education and research branches, and vertically, with senior managers completing FPM training and developing a clear focus on supporting partnership in their work. Clinical supervision offers an important venue for discussing this as a feature of everyday practice.

The philosophy of FPM and the difference it can make to families is embedded within the measures discussed above, but it is perhaps most powerfully conveyed in the words of this mother, quoted from a letter received by Karitane in October 2011:

“I did struggle some days, but the skills you learn are easily transferable and the ideas stay with you as you strive to keep hold of the positive new energy you have found… The entire experience, though daunting at first, is so well put together – you feel guided and supported, yet free within your own space to mother as you choose to. Techniques are gently and personally tailored to the way you have already been working with your baby so you feel that your values are respected. But every step of the way you are educated and informed as to how you could improve on what you are doing, such that you set about the process of achieving your goals. I also think that the key to the success of the Karitane experience is that it does not misrepresent itself as a ‘quick fix’. You realise that if you want to make changes, you must be the change you hope to see. Karitane teaches you how to do it on your own… As a mother I now have so much more energy to enjoy my baby!! I even try to make friends at the park rather than hiding away insecurely behind the trees with bags under my eyes! You helped me believe in myself again and gave my baby boy a great, strong, refreshed mummy!”

These data are reinforced by clinically validated measures of parents’ confidence (taken on admission and at discharge, consistently showing significant increases), and in discharge reviews, when parents are asked to assess progress on their goals. The Unit functions on short 5-day cycles, but addressing many parenting problems requires weeks or months. Hence the importance of using the period of residency to build confidence and capacity, beginning a journey of change that parents can continue in the home.

The costs and savings associated with the adoption and impact of FPM in child and family health services are difficult to quantify in purely economic terms. FPM is not designed to deliver lean efficiency, but rather to ensure the best possible outcomes for families.

The upfront outlay in terms of providing FPM Foundation training to clinical staff is modest, and the intense nature of the course reduces time buy-out costs. Literature and resources relating to FPM are available at minimal cost, and the approach taken by the Centre for Parent and Child Support in the UK encourages organisations to invest in a small number of staff completing additional FPM courses so they can then deliver training in-house (reducing costs of training staff) and connect with other services in their community. Compared to some other approaches the costs of implementing FPM are low.

The adoption of FPM at Karitane’s Residential Unit has not led to either increases or decreases in terms of staffing levels or everyday running costs. The Unit continues to support similar numbers of families each week, and the five-day period of residency for each family has not had to change. However, FPM has provided a basis for embedding a culture of co-production based on FPM across the workforce.

The savings offered by FPM spread well beyond any one organisation. It combines early intervention with an approach tailored to families’ needs, building on existing strengths in families and communities, and developing resilience. Thus services based on FPM offer a means for families to learn how to anticipate and address problems, disrupting the trajectories of their lives to reduce the risk of their health and wellbeing being placed at risk. In many cases this can reduce reliance on other services in the future, and can have long-term beneficial effects in terms of child health, educational achievement, and social contribution.

However, services like the Residential Unit also help some families make crucial connections to other sources of support – indeed, stays at the Unit often result in referrals to other services. This may lead to further service costs in the short-term, but again has lasting benefits.

It is important to remember that while many child and family services are expensive (Residential Units particularly so), they are funded out of a commitment to supporting families in need, giving children the best possible start in life, and aiming to keep children in secure family units wherever possible.

The success of embedding FPM at Karitane raises a number of points of wider relevance:

1. Changes oriented towards co-production benefit from being linked to specific, conceptually rigorous, and where available, research-based statements of values and the appropriate skills and practices that will allow these values to be put into effect. The FPM exemplifies this and is relevant across a range of health and welfare services for families and young people.
2. Investments in workforce development should be aligned with specific models of practice; education can be framed so as to tap into existing values and professional commitments, e.g. around a shared desire to deliver positive outcomes.
3. Cultural change in organisational practices needs to span across all horizontal sections of the organisation, as well as vertically down through it, and is supported when all staff, including all types of professionals, can embark on a journey of change together.
4. Organisations may need to provide ongoing support (in this case it was through clinical supervision) after training is completed.
5. Change must permeate practices and not be confined to novel additions to everyday work; this was seen in the relationship-focused nature of handover and case conferences at Karitane.
6. There is a risk that the pendulum can swing from dominance of the professional, to weak professionalism. FPM, and co-production more widely cannot be reduced to simply ‘being nice’ to service users; outcomes achieved at Karitane rely on professionals using their expertise to support, guide and challenge parents.
7. Changes dominated by a focus on cost saving and efficiency may lose sight of the longer-term benefits that flow from high quality services. Triggering sustained change may require initial and on-going investment. However, working differently may result from qualitative changes without needing increases or reductions in staffing levels, intensity of workload etc.
8. The impacts of partnership may be hard to capture in solely economic and other quantitative measures. Identifying the benefits of engaging with citizens differently is likely to require a mix of qualitative and quantitative, short and medium-term measures.

A user-focused report is available from online bookstores:

Hopwood, N. & Clerke, T. (2012), Partnership and pedagogy in child and family health practice: a resource for professionals, educators and students. Hertsellung: Lambert Academic Publishing.

The Centre for Parent and Child Support website is www.cpcs.org.uk, and can be contacted on info@cpcs.org.uk