agenda for children services: policy handbook
TRANSCRIPT
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The Agenda forChildrens Services:A Policy Handbook
Ofce o the Minister or ChildrenDepartment o Health and Children
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The Agenda forChildrens Services:A Policy Handbook
Oce o the Minister or Children
Department o Health and Children
December 2007
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Copyright Minister or Health and Children, 2007
Oce o the Minister or ChildrenDepartment o Health and ChildrenHawkins HouseHawkins StreetDublin 2Tel: +353 (0)1 635 4000Fax: +353 (0)1 674 3223E-mail: [email protected]: www.omc.gov.ie
Published by The Stationery Oce, Dublin
ISBN: 978-1-4064-2031-9Prn: A7/1892
All rights reserved. No part o this publication may bereproduced, stored in a retrieval system, or transmitted,in any orm or by any means, electronic, mechanical,
photocopying, recording or otherwise, without the priorpermission in writing o the copyright holder.
For rights o translation or reproduction, applications should bemade to the Head o Communications, Oce o the Minister orChildren, Hawkins House, Hawkins Street, Dublin 2, Ireland.
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Contents
Foreword by the Minister or Children v
A word rom stakeholders, children and young people vi
1 Aimsandobjectives 2How best to use this handbook 8
2 Promotinggoodoutcomesorchildrenandyoungpeople 12
3 Servicecharacteristicsneededtoachievegoodoutcomes 161. Connecting services with amily and community strengths 17
2. Ensuring quality services 20
3. Opening access to services 23
4. Delivering integrated services 26
5. Planning, monitoring and evaluating services 28
4 Gettingtheretogether 34Concentric circles o responsibility and delivery 34
Shared style o working 35
5 Keyconceptsorasharedlanguage 38
Useul publications and websites 42
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iv
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v
I am delighted to welcome the publication o this national policy document, The Agenda for
Childrens Services. It is an exciting and challenging time or all o us whose work concerns the
lives o children in Ireland. Never beore has there been such a concerted ocus on children,
their needs and what we as a society should do to respond to those needs.
The establishment o the Oce o the Minster or Children (OMC) within the Department
o Health and Children in 2005 was an expression o the Governments wish to advance
the agenda in relation to childrens services and represented a major milestone in theimplementation o the National Childrens Strategy. As Minister or Children, I attend Cabinet
meetings, thus enabling a direct input on childrens issues at Cabinet level. My Oce is
a rst in terms o public service management, in that three policy divisions in three
dierent Government departments are co-located together or the purpose o achieving
betters outcomes or children. The mandate given to the OMC is recognised in the current
social partnership agreement, Towards 2016. This agreement tasks the OMC with enabling all
parts o the public service management to work strategically together, at national and local
levels, so as to achieve more eective and ecient delivery o childrens services.
An important aspect o this policy document, The Agenda or Childrens Services, is the
emphasis placed on the role o amilies and communities in the lives o our children. Toooten in the past, services were provided to our children and young people in isolation rom
their amilies and communities. This was, and is, to the detriment o all concerned. The
inclusion o amilies, extended amilies and local communities, where possible, in services
or children goes a long way to ensuring that these services are actually responding to the
needs o the child and ensures that they continue to be eective in the long term, even
when direct intervention rom State or voluntary agencies has ceased.
This policy document builds on existing policies and places them in a ramework to assist
policy-makers, service managers and ront-line sta in meeting the needs o children and
their amilies. The Agenda is directing us all in a new way o working with children, their
amilies and communities, to ensure that our services are evidence-based, accessible,eective and sustainable. The inclusion o refective questions or the dierent levels o
practitioners is, in my view, a simple, yet eective way o ensuring that The Agenda is a
working tool or us and not just another policy document. It is the intention that The
Agenda serves as a broad statement o principles or all services concerned with children.
More specic policies in relation to certain aspects o services will be published at a later
stage.
I am condent that this document will assist all o us in our ongoing eorts to provide a
happy, healthy, sae, secure and participative environment or all our children and young
people.
BrendanSmith,TD
Minister or Children
Foreword
by the Minister for Children
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A word from stakeholders,
children and young people
ExtractsromquotesreceivedinthepublicconsultationontheNationalChildrens
Strategy,2000-2010
Id like to turn back the clocks o all the children in care so that they would
never have to go into care in the rst place.
Is Ireland a good place to grow up? Yes, i you are rom a loving amily, with
a decent income, supportive network and nice community However, i you
are less well o, have medical, learning or emotional needs, and the amily
situation is unstable or plagued by drink, drugs or depression, things are quite
dierent.
The needs o the child must be catered or in a holistic sense. The emotional,
physical, educational, societal and cultural needs should be looked at in the
context o the amily and community. The creation o building-up a sense o
belonging, o being a valued member o the community, should be incorporatedinto all services.
Id like there to be a real choice o placements or each child and young
person that is suitable to their needs.
It is welcome that the task o integration and partnership is being increasingly
identied as an intrinsic part o the work o State agencies and their sta, and
not an add-on.
vi
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Section1
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Aims and objectives
The purpose o this document is to set out the strategic direction and key goals o public
policy in relation to childrens health and social services in Ireland. (The term children is
used here to cover everyone under the age o 18 years.) Its aim is to assist policy-makers,
managers and ront-line practitioners to engage in reective practice* and eective
delivery, to be inormed by best Irish and international evidence, and to identiy their own
role within the national policy ramework.
This document is part o a undamental change now underway in how Government policyin relation to children is ormulated and delivered. The National Childrens Strategy or
the period 2000-2010 was the rst document to give clear expression to a commitment
to enhancing the status and improving the quality o childrens lives through integrated
delivery o services in partnership with children, young people, their amilies and their
communities (see Box 1). This commitment was both evidence-based and outcomes-
ocused*, is in line with the 1989 United Nations Convention on the Rights o the Child
(see Box 2) and refects best practice internationally and across the island o Ireland (see
Useul publications and websites at the end o this document). A range o policy documents
have reinorced these commitments over the years (see Box 3).
The ocus oThe Agenda or Childrens Services is on the key messages o existing policies inrelation to children. Together, these promote:
a whole child/whole system approach to meeting the needs o children;
a ocus on better outcomes or children and amilies.
In this context, supporting amilies is identied as the central concern underlying all
childrens health and welare services, whether aimed at prevention, early intervention,
hospital services, protection or out-o-home care. An objective oThe Agenda or Childrens
Services is to provide the means or operational managers and ront-line sta, particularly
in the Health Service Executive (HSE), to direct and evaluate their delivery o services
to children and their amilies against this strategic direction. A second objective is to
encourage all Government departments and agencies to adopt this approach in their policy
considerations and their services regarding children.
Box1:TheVision
An Ireland where children are respected as young citizens with a valued
contribution to make and a voice o their own; where all children are cherished and
supported by amily and the wider society; where they enjoy a ulflling childhood
and realise their potential.
Our Children Their Lives
TheNationalChildrensStrategy(2000),p.10
*Denitions o words highlighted in bold and ollowed by an asterisk (*) in the text are given in Section 5, Key concepts or a
shared language.
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Box2:UnitedNationsConventionontheRightsotheChild
RespectorchildrenasaglobalidealhasbeenafrmedbytheUnitedNations
ConventionontheRightsotheChild(UN,1989).TheUNGeneralAssembly
unanimouslyadoptedtheConventionontheRightsotheChildon20November
1989anditenteredintoorceorbecamelegallybindingonStatesPartiesin
September1990.IrelandratifedtheConventionin1992.
TheConventionspellsoutthebasichumanrightstowhichchildreneverywhereare
entitled.Theseare:
therighttosurvival;
therighttothedevelopmentotheirullphysicalandmentalpotential;
therighttoprotectionrominuencesthatareharmultotheirdevelopment;
therighttoparticipationinamily,culturalandsociallie.
TheConventionprotectstheserightsbysettingminimumstandardsthat
governmentsmustmeetinprovidinghealthcare,educationandlegalandsocial
servicestochildrenintheircountries.
TheConventiondefnesachildasapersonbelowtheageo18,unlessthelawsoaparticularcountrysetthelegalageoradulthoodasyoungerthan18.
TheguidingprinciplesotheConventionare:
allchildrenshouldbeentitledtobasicrightswithoutdiscrimination(Article2);
thebestinterestsothechildshouldbetheprimaryconcernodecision-
making(Article3);
childrenhavetherighttolie,survivalanddevelopment(Article6);
theviewsochildrenmustbetakenintoaccountinmattersaectingthem
(Article12).
In2005,IrelandsubmitteditsSecondReportontheimplementationothe
ConventiontotheUNCommitteeontheRightsotheChild(NCO,2005;or
urtherinormation,seewww.omc.gov.ie).
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Box3:ProgrammeoHealthandSocialServicesReorm
(ull details o publications on pages 42-44)
The National Childrens Strategy:
Our Children Their Lives (2000)
This strategy sets out a series o
objectives to guide childrens policy over a
10-year period. It identies six principlesto guide all actions to be taken and it
proposes a more holistic way o thinking
about children.
Quality and Fairness A Health System
for You(2001)
This strategy sets out overarching
goals and a programme o investment
and reorm or a 10-year period or thehealthcare system. It envisages cross-
disciplinary collaboration to achieve
new standards, protocols and methods.
Primary Care A New Direction(2001)
This document sets out a blueprint
or the planning and development o
primary care services over a 10-year
period. It proposes the introduction o an
interdisciplinary team-based approach on
a phased basis.
Transormation Programme 2007-2010
(2006)
This document was developed or all
sta working or the Health Service
Executive (HSE). It has six priorities,
which include the development o
integrated services; the conguration oservices to deliver optimal and eective
results; the implementation o standards-
based perormance measurement and
management; and the engagement o all
sta in transorming health and social
care. These priorities will be addressed
through 13 dierent Transormation
Programmes, which ocus on improving
the services that patients, clients and
carers receive, and on improving the
HSEs inrastructure and capability toprovide and support those services.
National Action Plan or Social
Inclusion 2007-2016: Building an
Inclusive Society(2007)
This plan, complemented by the social
inclusion elements o the National
Development Plan 2007-2013,
Transforming Ireland A Better Quality of
Life for All (2007), sets out how the social
inclusion strategy will be achieved over
the period 2007-2016. The new strategic
ramework acilitates greater coordination
and integration o structures and
procedures across Government at national
and local levels, as well as improved
reporting and monitoring mechanisms. The
plan includes specic targets and actions
relating to children.
A Vision for Change Report of the
Expert Group on Mental Health Policy
(2006)
This report proposes a ramework o mental
health service delivery with the service
user at its centre. It details a series o
actions or developing a comprehensive
person-centred model o mental health
service provision, including the urtherdevelopment o community-based,
multidisciplinary teams.
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Box3:ProgrammeoHealthandSocialServicesReorm
(ull details o publications on pages 42-44)
Reach Out Irish National Strategy for
Action on Suicide Prevention 2005-2014
(2005)
This strategy builds on the work o the
National Task Force on Suicide (1998). It sets
out an evidence-based, pragmatic approach
or prioritising actions to be taken over the
next 5 to 10 years in order to eect real
change. The strategic ramework sets out
a partnership approach between statutory,
voluntary agencies, community groups and
individuals, supported by Government.
Disability Act 2005: Sectoral Plan or
the Department o Health and Children
and the Health Services(2006)
The ocus o the Disability Act 2005, a
key element o the Disability Strategy, is
on mainstreaming and social inclusion
and is given particular emphasis
through the Sectoral Plans provided or
under the Act. The plan sets out actions
or the Department o Health and
Children, the Health Service Executive
and other statutory bodies.
National Drugs Strategy 2001-2008
(2001)
This strategy is based on our pillars
supply reduction, prevention, treatment
and research and approximately 100
actions have been identied or a number
o Government departments, including
Health and Children.
Report o the Working Group on the
treatment o under-18 year-olds
presenting to treatment services with
serious drug problems(2005)
This report is an important element
o the Drugs Strategy and sets out
ways to achieve the recognition o an
individuals drug misuse and appropriate
interventions. It emphasises the need
or a multidisciplinary approach. It
recommends a our-tiered model o service
delivery, which provides a realistic,
fexible and adaptable ramework.
Report of the Working Group on Foster Care:
A child-centred partnership(2001)
This report sets out good practice guidelines
and recommendations or the development
o oster care services in Ireland to meet the
needs and demands o children, their amilies
and oster carers.
Childrens Health First Internationalbest practice in tertiary paediatric
services: Implications or the strategic
organisation o tertiary paediatric
services in Ireland(2006)
This report was commissioned to advise
on the strategic organisation o tertiary
paediatric services or Ireland that would
be in the best interests o children. The
conclusion o the report is that compelling
evidence exists or one national tertiary
paediatric centre based in Dublin. The
proposed assessment criteria or planning
such a centre include providing a patient-
and amily-ocused environment and services.
A Strategy or Cancer Control in Ireland
(2006)
This strategy sets out uture
recommendations or the provision o
cancer services. It acknowledges the good
perormance o Ireland in relation topaediatric oncology and recommends that
this be maintained.
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Box3:ProgrammeoHealthandSocialServicesReorm
(ull details o publications on pages 42-44)
Children First: National Guidelines for the
Protection and Welfare of Children(1999)
These guidelines were developed to
support and guide health proessionals,teachers, Garda and others who come in
contact with children through sporting,
cultural, community and voluntary
organisations. The report provides people
with a set o sound principles and good
practice guidelines.
Report on the Youth Justice Review
(2005)
This report aims to identiy the
leadership and coordination mechanismsnecessary or eective service delivery
or children appearing beore the Courts.
It emphasises the need or the justice,
health and education systems to work
eectively together to achieve better
outcomes or children.
Review o the National Health
Promotion Policy 2000-2005(2005)
This review establishes the progress
made to date in implementing theobjectives o the 2000-2005 National
Health Promotion Strategy, in addition
to identiying the areas where progress
has yet to be made and making
recommendations or urther action.
Youth Homelessness Strategy(2001)
This strategy sets out specic actions or key
stakeholders, e.g. HSE, Education. The goal
o the strategy is to reduce and i possibleeliminate youth homelessness through
preventative strategies and to ensure
that a comprehensive range o services
are available or those homeless children,
aimed at re-integrating them back into their
communities as quickly as possible.
Breasteeding in Ireland A fve-year
Strategic Action Plan(2005)
This action plan sets out time-
ramed targets and actions to provide
lead agencies with a template or
implementation, aimed at greatly
improving breasteeding rates in Ireland.
Strategic Task Force on Alcohol,
Second Report 2004(2004)
This report sets out recommendations
aimed at enhancing societys capacity
to prevent and respond to alcohol-related harm, to achieve WHO targets
and or early intervention to ensure
eective treatment to reduce high
risk and harmul drinking and alcohol-
related problems.
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It is anticipated that The Agenda or Childrens Services will serve as a broad policy
ramework document, which will enable, as required, the development o new or revised
Government policies in specic areas o childrens services. These new or revised policies
will set out detailed actions and will be developed in consultation with operational
managers and ront-line sta and, where appropriate, with Government departments and
the wider public service, the voluntary sector and with children, young people and their
amilies and communities.
Considerable work was done by the National Childrens Oce (the NCO, incorporated in
2005 into the Oce o the Minister or Children, the OMC) to realise the three central
goals o the National Childrens Strategy, namely:
children will have a voice;
childrens lives will be better understood;
children will receive quality support and services to promote all aspects o their
development.
The Oce o the Minister or Children (OMC) is now driving that work urther orward rom
within the Department o Health and Children. It does this through developing policy on
childrens health and welare, contributing to the development o early years educationand youth justice policy, and generally promoting the interests o children across all
Government departments and within the wider society (see Box 4). Further momentum or
change was generated by the Departments review in 2004-06 o Family Support Services,
which involved a signicant amount o consultation, analysis and strategic thinking on
how best Government can deliver quality services to support all aspects o childrens lives
(Department o Health and Children, 2007a, b and c).
Box4:RoleotheOfceotheMinisterorChildren
Inordertobringgreatercoherencetopolicy-makingorchildren,theGovernment
establishedtheOfceotheMinisterorChildren(OMC)in2005.TheOMCisanintegralpartotheDepartmentoHealthandChildren.Itsocusison
harmonisingpolicyissuesthataectchildreninareassuchasearlychildhood
careandeducation,youthjustice,childwelareandprotection,childrenandyoung
peoplesparticipation,researchonchildrenandyoungpeople,andcross-cutting
initiativesorchildren.TheOMCsupportstheMinisterorChildrenindrivingthe
implementationo:
theNationalChildrensStrategy(2000-2010);
theNationalChildcareInvestmentProgramme(2006-2010);
policyandlegislationonchildwelareandchildprotection;
theChildrenAct,2001andtheChildCareAct,1991.
TheOMCalsomaintainsageneralstrategicoversightobodieswithresponsibility
ordevelopinganddeliveringchildrensservices.
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A signicant programme o reorm has taken place in health and social services in recent
years with the establishment o the Health Service Executive (HSE) and its national and local
structures. In this reormed organisational context, underpinned by the HSEs Transormation
Programme 2007-2010, a real opportunity exists to shape service development and delivery
so that national policy can be eectively translated into improvements in the lives o
children and their amilies (HSE, 2006a). In addition to the National Childrens Strategy, a
series o sectoral plans, strategies, policies and legislation are in place (see Box 3). These
include the Disability Act 2005: Sectoral Plan (Department o Health and Children, 2006a);
A Vision or Change: Report o the Expert Group on Mental Health Services (Government
o Ireland, 2006); Primary Care A New Direction (Department o Health and Children,
2001a); Childrens Health First International best practice in tertiary paediatric services
(HSE/McKinsey & Company, 2006b). These strategies and policies are not only specic and
detailed in their ocus on the services that are required or meeting particular needs; they
also recognise the needs o the whole child and the requirement or integrated service
design and delivery within the whole system.
The energy and commitment that so many people, adults and children, have invested in
these policy developments, together with the skills and resources now committed to the
daily delivery o services to children across the ull range o their needs, have created a
momentum or change to better the lives o all children and young people. The inclusion
o the needs o children as part o the liecycle approach adopted in the current national
agreement, Towards 2016, is an indication o the heightened policy prole now accorded to
children by both Government and the social partners. The challenge now is to ensure that
this signicant policy advance at national level is translated into good outcomes that can
be seen in the day-to-day lives o children themselves. The Agenda or Childrens Services is
a tool to assist in that task.
How best to use this handbookThe Agenda or Childrens Services is not to be regarded as a static document, but as an
active policy tool. In order to advance needs-led, outcomes-ocused* services, a set
o key concepts (see Section 5), explanatory rameworks (see Figures 1-6) and refective
questions (see Boxes 5-9) are provided. These have been developed to support, respectively,
those involved in service delivery, management and policy-making. Working through these
key concepts, explanatory rameworks and refective questions, sta at all levels o the
health and social services system should be able to actively engage in delivering services
that express both the general thrust o national childrens policy and the specic policies
relevant to their area o work.
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These materials should orm the basis or reectivepractice* at the level o the organisation,
group, proessional, team and individual, and serve as a basis or discussions at seminars,
conerences, service reviews and case discussions. The materials have been designed or
photocopying and scanning, and or the creation o interactive media. In this way, The
Agenda or Childrens Services aims to enable everyone involved in childrens services to
take personal responsibility or advancing the national goal o needs-led, evidence-based
services that promote good outcomes or children.
Figure1:UsingThe Agendatocreateawholechild/wholesystemapproachtopromoting
betteroutcomesorchildren
Underminingcircumstances
andlieevents Betteroutcomes
Pooreroutcomes Prevention Earlyintervention Communityserviceprovision
Out-o-homecare Protection
Reducethequalityothelivesochildren,
amiliesandcommunities
Enhancingthestatusandimproving
thequalityochildrenslivesthroughstrongandhealthyamiliesand
communities
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Section
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1
At the core oThe Agenda or Childrens Services is the promotion o what we want or our
children good outcomes: the best possible conditions, situations and circumstances to
live their lives to their ull potential. Outcomes are about both what is happening nowin
childrens lives and what may happen or them in the uture. Outcomes address both the
being and the becoming o childhood. Although there is considerable consensus about
the types o outcomes that are desirable or children across the various dimensions o their
lives and considerable understanding about how to achieve them, there continues to be
many dierent ways in which these outcomes are described. As a way o ensuring a common
language o outcomes within childrens services, The Agenda draws together the various
types o outcomes ound in contemporary childrens policy and presents them here as a
single list o 7 items:
The7NationalServiceOutcomesorChildreninIreland
healthy,bothphysicallyandmentally
supportedinactivelearning
saeromaccidentalandintentionalharm
economicallysecure
secureintheimmediateandwiderphysicalenvironmentpartopositivenetworksoamily,riends,neighboursandthecommunity
includedandparticipatinginsociety
These 7 National Service Outcomes or Children are intentionally ramed as active, strengths-
based and positive. Childrens services aimed at promoting these outcomes need to recognise
that not only do children need active support but that children are themselves resilient*
active participants in their own lives and the lives o those caring or them.
As set out in Figure 2, it is the pursuit o better outcomes that should drive the ormulation
o policy and it is the expression o policy within services that then ensures the desired
outcomes are achieved. It is the successul combination o policy and services that achieves
good outcomes. Achieving good outcomes requires that policy-makers, planners, service
managers and ront-line sta all take responsibility to work towards them. This requires
understanding and committing to the 7 National Service Outcomes or Children and to
ensuring that sectoral plans and strategies, and organisational priorities all contribute to
their attainment.
Particular outcomes must be the ocus o particular services good health requires medical
services and health promotion; educational achievement requires schools; being sae rom
abuse requires child protection services; being secure in the immediate and wider physical
environment requires an active local authority and active community policing. But alongside
this is a shared responsibility refecting the complex overlapping task o achieving good
outcomes or children. Ensuring that services take into account the whole child and benet
Promoting good outcomes
for children and young people
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1
rom the range o available services requires a shared perspective. Where appropriate, there
needs to be joint working through the identication o lead responsibility towards specied
outcomes. This is necessary rom senior levels in the Departments o State through to the
interagency planning, service-level agreements and integrated service delivery to individual
children and their amilies.
Figure2:Betteroutcomeswhenpolicy-makersandserviceprovidersworkstrategically
together
Joined-up whole system government at national and local level has been identied in the
report by the National Economic and Social Council, entitled The Developmental Welare
State, as central to the reorm and development o Irelands social policies (NESC, 2005).
Commitments in relation to the children liecycle in the current national agreement, Towards
2016, refect this imperative: or example, multisectoral Childrens Services Committees are
to be established in each county. The OMC has adopted the lead role in the childrens
policy arena, taking responsibilities in child welare and protection, childcare, early years
education, youth justice and the National Childrens Strategy. But the achievement o the
7 National Service Outcomes or Children requires an even wider and deeper engagement
by all departments, agencies and services with responsibility, however limited, or children.
To support the achievement o whole system delivery, new interdepartmental, cross-agency
and multidisciplinary ways o working will be needed. The Childrens Services Committees,
mentioned above, may represent a way orward in this regard.
POLICYSERVICES
OUTCOMES
aspiredor
achieved
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Throughensuring the policy, organisational support and practice methods that promote
a wholechild/wholesystemapproach*, better outcomes or children can be achieved.
Children and amilies should be able to expect that whatever the ocus o the service they
are receiving (e.g. prevention, early intervention, community services, hospital services,
protection or out-o-home care), they will experience it as:
whole child/whole system ocused;
accessible and engaging; coherent and connected to other services and community resources;
responsive to their needs;
staed by interested and eective sta;
culturally sensitive and anti-discriminatory.
Standards or some childrens services have been developed and good practice service models
have been identied in many areas. All service providers should aim to meet these standards
where they apply and to meet the targets, aims and outcomes o the identied good practice
models (or examples,see Useul publications and websites).
1
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Section
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In order to promote the 7 National Service Outcomes or Children, services need to strive to
achieve 5 essential characteristics:
1. Connecting with amily and community strengths.
2. Ensuring quality services.
3. Opening access to services.
4. Delivering integrated services.
5. Planning, monitoring and evaluating services.
Achieving these qualities requires constant attention. To help ensure this happens, each o
the 5 characteristics is discussed in the ollowing pages and linked with a set o refective
questions which those involved in service delivery might ask themselves. There are separate
questions or policy-makers, or HSE senior managers and or ront-line service managers and
practitioners (see Boxes 5-9).
Central Government cannot, and should not, direct the day-to-day judgements and activities
o childrens services sta. It is, however, essential that sta at all levels play their role in
delivering on the strategic direction and standards o service that Government, through the
HSE, sets out. The refective questions posed or each o the 5 characteristics are intended
to promote the whole child/whole system delivery approach at the heart o present-day Irish
childrens policy. By considering these questions, sta at all levels can audit or themselves
and or others how closely they are complying with the direction o national policy. Refecting
on their answers will not only encourage closer compliance across all services and between
services, but also identiy best practice and the barriers to achieving it. It will also encourage
innovative thinking and problem-solving.
1
Service characteristics
needed to achieve good outcomes
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Connecting services with family
and community strengths
Ensuring that children and young people receive the support they need when they need it is
the central challenge or childrens services. This requires that ormal services connect with
and promote the networks o inormal support that surround children and young people (see
Figure 3). Supporting and complementing the many ways in which the immediate amily
protects and cares or children is the central unction o child health and child welare
services.
This is easier to achieve with some amilies than others. Social exclusion is a major barrier toeective support and needs to be directly addressed through targeting need and developing
and delivering culturally competent services. Eective protection o children and young
people at risk or in crisis, as well as the promotion o all childrens well-being, requires
working in partnership with amilies. Retaining the trust o amilies is the key. With regard
to children with disabilities, it also requires careul handling o sometimes complex ethical
and legal considerations relating to consent. This is particularly important when dealing
with those who are most vulnerable and those children and amilies who are most dicult
to engage. In child health and welare, there is now a clear recognition that eective
support or amilies requires universal provision, plus, within that, the targeting o services
to children and amilies at risk o social exclusion, in line with the NESCs report on the
Developmental Welare State (NESC, 2005).
Figure3:Acuppedmodeloamilysupport
MEETINGCHILDRENSNEEDS
Child/Young Person
Immediate Family
(inormal support)
Wider Family/Friends(inormal supports)
Community
(inormal support)
Community/Voluntary/Statutory
agencies and organisations
(ormal services)
National Government
(policy/legislation)
1
1
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The support that children receive rom other inormal sources beyond their immediate amily
also needs to be recognised the wider amily, riends and community. There is strong
evidence that or children in adversity it is these inormal networks that are the key sources
o help and yet they are oten overlooked by proessionals. Help rom these networks can be
available on a 24-hour basis in a less stigmatising ashion and can be very cost-eective.
They operate in the immediate world o the children and young people. They should
always be considered by proessionals and services as a major resource or assessment and
interventions. This applies in every situation o child health and welare service provision
whether the aim is prevention, early intervention, community services, hospital services,
child protection or out-o-home care.
Services need to identiy, understand and optimise the strengths within the inormal
networks o which children are a part whilst not ignoring the limitations and the harm
that amilies, neighbourhoods and communities can hold or children. At all levels o policy-
making, management and practice, there needs to be an explicit and active commitment
towards utilising amily, riends and community in working with children. This requires
much greater innovative thinking in assessing, using and resourcing inormal networks o
support so as to benet rom their strengths whilst recognising their limitations.
1
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All those involved in service development and delivery need to work together towards
constantly raising the quality o practice. This requires ront-line sta, service managers and
others to ensure that the services they provide are matched to SMARTplanning* or better
outcomes, in line with ormal quality standards and accreditation requirements where these
exist. (SMART is an acronym or activities that are specic, measurable, attainable, relevant
and time-based.) This requires ensuring services are eective and ecient in meeting
specied outcomes and that needs are clearly matched to appropriate services. Standards
need to be applied to both services and to outcomes.
Achieving quality child health and welare services requires that service delivery is based on
the accurate identication o need matched to service design and intervention. Thus, beore
any intervention is made, services need to be able to demonstrate how they have identied
the needs o amilies in particular areas, in particular categories or individually, and that
subsequent delivery o services is geared toward the outcome o meeting identied needs.
It is also essential that consideration is given to what other services have to bring to the
process o assessment, intervention and evaluation. In cases where the child or the amily is
already engaged with multiple services, clear processes or communication and collaborative
working between agencies must be agreed and put into practice. Within this context, it is
incumbent on proessionals and services to uphold the rights o children and amilies in
particular, the rights o children as outlined in the UN Convention on the Rights o the Child
(see Box 2).
As part o developing a needs-led service, proessionals must retain a ocus on the
inclusiveness o children and amilies as central players in the design, implementation and
evaluation o services. This involves working in partnership with service users i.e. the
service users having their say on both their needs and on the services and ways o working
that they see as best meeting their needs. Working in partnership must involve children
as much as it does the adults who care or them. It also requires ront-line proessionals
exercising their proessional judgements and working these into agreements about needs,
services and outcomes with service users. This process o engagement, between sta
delivering services and amilies using them, needs to be recorded over time, through the
stages o assessment, design, implementation and evaluation o outcomes.
0
Ensuring quality services
2
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Box
6:Refectivequestionson(2)Ensuringqualityservices
Que
stionsabout:
Quest
ionsor
POLICY
-MAKERS
Questionsor
HSESENIORMANAGERS
Questionsor
FRONT-LINESERVICEMANAGERSANDPRACTITIONERS
SMA
RTworking
tow
ardsoutcomes
Ismypolicyocusedonachieving
clearoverarchin
goutcomesor
children?
Whataretheou
tcomesorwhichmy
departmenthas
leadresponsibility?
Aretheseoutcomesachievableand
measurable?
Whatarethestructures,processes
andtimetablesthatareinplaceto
achievetheseoutcomes?
Arethepolicyspecicsorwhich
Iamr
esponsibleconsistentwith
theachievementotheagreed
outcomes?
Areservic
esdesignedtoocusonthe
achievementoparticularoutcomesinline
withTheAgendaforChildrensServices?
Howandtowhatextentcanitbe
demonstratedthatthedesiredoutcomesare
beingach
ieved?
Areservic
esorganisedsoastoencourage
andacilitatecollaborationwithothers?
Whatspecicoutcomesorchild
renismywork
currentlyocusedon?
DoIconsiderthewholechild,i.e.
theimportance
ooutcomesotherthanthoseI
amd
irectlyseeking
toachieve?
HowcanImeasureitheserviceisachievingsuch
outcomes?
Withwhoma
ndinwhatwaysam
Icollaborating
withotherservicestoidentiya
nddeliveronthose
outcomes?
InwhatwaysamI
workinginpartnershipwith
amiliestoidentiyanddeliveronthoseoutcomes?
Qua
lityassurance
Whatramework
sareinplace
toinormt
hede
velopmento
qualitystandard
s,havingregard
tobestpractice
andinternational
experience?
Doesthepolicy
rameworkor
whichIamr
esp
onsibleencourage
corporateserviceplannersand
ront-linestatooptimiseavailable
resourcesandpromoteearly
intervention?
IsthepolicyclimateIamh
elpingto
createencouragingoinnovationin
supportingamilies?
Whatarethequalitystandardsagainstwhich
servicede
sign,andtheimplementation
opolicythroughservicedelivery,
is
happening?
Inwhatw
ayscanitbeshownthatservices
areworkin
gecientlyandeectively?
DoestheorganisationalclimateIam
helpingto
createencourageinnovationin
servicede
signanddeliverywithinanoverall
ramework
oasharedstyleoworkingand
anapproa
chosupportingamilies?
DoIseek
todisseminatesuchinnovation
widely?
Whatarethequalitystandardsa
gainstwhichIam
measuringdeliveryoservices?
AmI
makingthebestuseothe
resourcesIhave
atmydisposal?
DoIconsiderinnovativewaysodeliveringa
qualityservice?
1
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Box6:Refectivequestionson(2)Ensur
ingqualityservices
Questionsabout:
Question
sor
POLICY-M
AKERS
Questionsor
HS
ESENIORMANAGERS
Questionsor
FRONT-LINESERVICEMANAGERSAND
PRACTITIONERS
Needs
-led
servic
es
Isthepolicyrame
workdesigned
aroundmeetingtheidentiedneeds
ospeciccategoriesoamilies?
Whatarethestructuresand
processesinplace
toacilitate
participationbych
ildrenand
amiliesinpolicyd
evelopmentand
implementation?
Aretheremeasures
inplaceby
whichIcanidentiytheimpacto
theparticipationb
ychildrenand
amiliesontheorma
ndnatureo
policy?
Aretheservicesdesignedandorganised
aroundmeet
ingtheneedsoserviceusersin
awaythatk
eepstheprincipleosupporting
amiliesinocus?
Areservices
ullyinclusiveothevoiceand
expertiseo
thechildrenandamilieswho
utilisethem?
Towhatexte
ntcanIenhanceservice
participation
bychildrenandamilies
intermsoa
ssessment,deliveryand
evaluation?
Istherethe
capacityorjointneedsanalysis
andplanningacrossservicesandsectors?
HowdoIassessneedsandwhodo
Iworkwith
todothis?
HowdoIkeeptheprincipleosup
portingamilies
asakeyconsiderationinrelationt
oneed?
HowdoImatchidentiedneedto
planningand
deliveringservice?
InwhatwayscanImeasuretheeective
involvementochildrenandtheiramiliesinthe
processoassessment,planning,interventionand
evaluation?
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Health and social care services or children do not exist as an alternative to the care
and concern that generally only amilies and communities can provide in a sustained and
eective manner. Services exist to complement, reinorce and extend the capacity o amilies
and communities. Just as amilies meet the ull range o children and young peoples needs
(emotional, intellectual, social, cultural and material), so too must there be a wide range
o services available to children and those who care or them. These need to be provided at
a series o levels o need and matched services, (see Figure 4). Families with more complex
needs require more complex services, or which the State must take greater responsibility.
Figure4:Levelsatwhichamiliesneedsupport
Source: Adapted rom Hardiker et al (1991)
In Figure 4, Level1 provides open access support to amilies (such as public health nurse
or GP services) and health promotion and inormation services (such as advice on good
nutrition). By contrast, Level2 support, while still provided to amilies at their request,
is targeted by assessment o need and mandated by the State as part o its responsibility
towards supporting amily lie. At Level3, support is better described as intervention to
Opening access to services
3
Intensiveandlong-termsupportandrehabilitation
orchildrenandamilies
Servicesorchildrenandamilieswithseriousdifculties,includingrisko
signifcantharm
Supportservicesorchildrenandamiliesinneed
Universalservicesandcommunitydevelopmentavailabletoallchildrenandamilies
LEVEL4
LEVEL3
LEVEL2
LEVEL1
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indicate that the voluntary element is gone because severe and established diculties
placing children at risk have been assessed and work with the amily is mandated by law,
oten through the Courts. At Level4, the need within a amily is so acute or the coping
capacity so weak that children and young people have to be placed in medium or long-term
out-o-home care. Work at Level 4 is also about lowering the level o need and/or improving
coping so that re-engagement with services at the lower levels can become sucient.
The closer services are to providing or the sel-assessed needs o amilies and children, themore likely they are to be accessed. Services need to be primarily ocused at Level 1 and be
provided on an open access basis as part o community development. Not every amily will
want to use these services, but should have access to them. Services, just like amilies, must
meet childrens need or protection rom harm as well as or promoting their well-being and
development (e.g. education, play/leisure, built environment, child protection). Services
must also be able to meet dierent levels o need and have a special responsibility where
the level o need is greatest (e.g. acute illness, disability, school reusal, law breaking,
homelessness, rural isolation, ethnic/cultural dierence and poverty). Every eort should
be made to provide easy access to services through outreach to individual children, their
amilies and their communities. This requires making available non-stigmatising, multiple
access points. Services also need to make ull use o collaborative cross-reerrals.
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Most Government departments and their agencies have children among those who benet
rom their services. Many children will receive a range o these services and oten their
needs will cross departmental boundaries. Children need to be seen as at the centre o
these services. There is now widespread recognition that just as children live their lives
in the round, so too must the services be holistic in their orientation and t together
in an integrated ashion. This whole child/wholesystem* approach ensures that the
eectiveness o any particular service benets rom being reinorced and complemented by
other services working together, or and with children. Each agency has a responsibility to
articulate and act on its own goals in regard to the shared outcomes and be clear as to how
it can demonstrate that this is being done.
Working together can ensure a clearer ocus and more accurate targeting o services. It can
also make or more cost-eective delivery through avoiding duplication, combining impact
and getting synergy through the sharing o inormation and the cross-ertilisation o ideas.
Conusion and duplication can be reduced and more impact achieved to ensure good outcomes
or children. Integration needs to occur at the policy, planning and commissioning levels,
so that opportunities are provided or conjoint interagency working, including delivering
specic packages o care.
Delivering integrated services
4
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Box
8:Refectivequestionson(4)Deliveringintegratedservices
Que
stionsabout:
Questionsor
POLICY-MAKERS
Questionsor
HSE
SENIORMANAGERS
Questionsor
FRONT-LINESERVICEMANAGERSAN
DPRACTITIONERS
Strategically
integrated
services
Doesmydepartmentspolicy
explicitlysupportintegrated
serviceplanning
anddesign?
DoIcollaborate
withpartnersin
otherdepartmen
tsinprovidinga
wholechild/wh
olesystempolicy
ramework?
Domyorgan
isationalstructuresand
processesen
couragejoined-upworking
acrossservic
esandsectorsbasedonparity
oesteem?
Whatincentives,includingnancial,arein
placetopromotejointplanning,service
designandd
elivery?
Areleadagenciesidentiedtodealwithkey
issues?
Areservicesdeliveredinawaythatrefecta
commitmenttothebasicvaluesan
dstrategic
objectiveoawholechild/wholes
ystemperspective?
Isthereanaccessiblelocalregisterotherangeo
availableserviceseducational(sc
hool,colleges),
medical(primarycareunits,
hospit
als)andsocialcare
(ater-schoolschemes,amilycentres,socialservices)
whichproessionalscanusetoassistamiliesto
accessservices?
Doorumsexistlocallyorbringing
togethersta
roma
crossservicesandsectorsto
shareknowledge
andexpertise,soastoencouragec
ooperativeworking
withanemphasisonamiliesinth
ecommunity?
Integratedcase
management
Doesmydepartmentspolicy
promoteintegra
tedcase
managementat
thelevelo
servicedelivery?
Isthereanintegratedhumanresources
ramework(i
ncludingtraining)tosupport
theintegrati
onoservices,which
includesutilisingtheresourceoamily
andcommun
itiesorassessmentand
interventions?
Doinormati
onandcommunication
systemsacilitatecross-serviceandsector
communication?
Docasemanagementproceduresan
dprocessesbring
togetherallthosepeoplewhohave
somethingto
contributetounderstandingandre
spondingtothe
needsoparticularchildren?
Whatarethebarrierstointegrated
casemanagement
andhowcantheybeovercome?
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This document is about how policy and services can result in the achievement o outcomes
or children. It implies an iterative, rational cycle involving planning, implementation,
ongoing monitoring and evaluation. As Figure 5 shows, policy-makers and service providers
must start with the desired outcomes or children and then build planning, implementation,
monitoring and evaluation processes rom there.
A undamental requirement or this approach is to establish an agreed set o indicators by
which the achievement o outcomes or children can be assessed. In addition, indicators arerequired to assess the strategies, inputs, processes and activities that are used in achieving
these outcomes. Critically, indicators are required at both policy and implementation levels
within an integrated ramework. Higher level policy outcomes and indicators rame and are
ormed by outcomes and indicators at the implementation level (as illustrated in Figure 5).
Figure5:Monitoringandevaluationcycle
Planning, monitoring
and evaluating services
5
Inevitably, such a simplied model as shown in Figure 5 masks the complex reality o
deciding and agreeing outcomes and indicators, at policy and implementation level, either
within a single policy domain or in relation to multi-sector outcomes. To help with that,
this document sets the overall ramework in the 7 high-level National Service Outcomes or
Children. The next task is or departments, agencies, services and projects to work out what
are the most appropriate indicators o outcomes or which they are responsible, either solely
or in partnership with others. Implicit in this is the need to nd a way to work eectivelyin partnership, in the wider context o joined-up government.
Indicators
7NationalService
OutcomesorChildren
ImplementandMonitor
PlanEvaluate
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In all this, robust inormation systems are a key ingredient in helping dene outcomes
and making plans to meet them; or monitoring the implementation o policies, programmes,
services and projects; and or asking clear evaluation questions about whether or not the
intended outcomes have been achieved. All recent national policy documents relating to
children refect a commitment to quality inormation systems. Clear inormation based on
relevant indicators allows or progress to be monitored over time and an evaluation to be
made o whether things are getting better or children or not. Such inormation requires the
establishment o baselines, where none exist, and the routine collation and evaluation o
inormation generated in the course o service delivery, along with commissioned strategic
research.
Some o the criticisms o inormation systems and data requirements in the past were that
there was no clarity as to why particular inormation was needed and or what it would be
used. Perhaps more signicantly, there was no transparent process o giving eedback on the
analyses o data provided or the implications o such analyses. For inormation recording to
be meaningul locally, such practical useulness, locally on site, regionally and nationally
must be readily apparent to service managers and practitioners. Inormation systems and
recording must be supportive o refective services and refective practitioners, as well as
meeting national planning and accountability unctions.
A urther criticism o inormation systems is their tendency to be just about numbers.
Approaches to planning, implementing, monitoring and evaluating services need to be
underpinned by a value commitment to listening to what children and their amilies think
about the services they receive and what these services mean to them. The important
role o such qualitative data must be acknowledged alongside appropriate quantitatively
based judgements. The two types o inormation need to be combined in both routine
administrative data systems and commissioned strategic research in order to achieve useul
monitoring and evaluation o the achievement o outcomes or children.
The Department o Health and Children is currently preparing drat legislation to give astatutory ramework to the Health Inormation Strategy.
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Section
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Concentric circles of responsibility
and delivery
The direction o services outlined here cannot be achieved without clear assignment o
Departmental responsibilities. Recognition must be given to the specic requirements and
dierences between those services that are universal and those that are tightly targeted,
between those that are supportive and those that are custodial. Each will have its ownpolicy and organisational ocus and concerns. However, these must be supplemented by
partnership structures and a shared pursuit o the whole child/whole system approach (see
Figure 6).
The Oce o the Minister or Children (OMC) will direct these partnerships in the areas that
it has direct responsibility or and promote them in other areas that are relevant to its work.
The OMC has responsibility to ensure that priority is given to those most in need, while at
the same time ensuring that children and amilies with less pressing needs are also able to
access appropriate support and services.
Figure6:Spheresoresponsibility
Getting there together
The OMC will ensure that there is a coordinated business plan or childrens services, based
on the strategic plans and annual business plans o various Government departments and
agencies providing services to children. This will be used to direct action towards achieving
the 7 National Service Outcomes or Children, to monitor progress towards their achievement
and to seek solutions to identied barriers and unresolved issues. This will require the
promotion o a common language. At the same time as providing specic direction, the
OMC (in line with the NESCs concept o a DevelopmentalWelareState*) will ollow the
principle osubsidiarity*, respecting the contributions made by the variety o stakeholders
at their dierent levels in the system and in ways that t their particular policy and
organisational ocus and concerns. The key goal o the OMC is to engage all those who have
a contribution to make.
OfceotheMinisterorChildren
Societyasawhole
DepartmentoHealthandChildren
HSE
Localchildrensservicesagencies
Agenciesthatimpactonchildrenslives
OMC
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Shared style of working
In order to implement any policy in the eld o human services, it is essential to be aware
that uniormity in the design o interventions does not equal uniormity in the practice
o workers. Just as individual services can dier according to dierences in location and
the nature o the target population, so too can individual work practices dier, with the
personal practice style o some workers managing to achieve more than others, irrespective
o training or resources. In order to address this aspect o delivering better services, a
shared style o working needs to be promoted. Underpinned by core practice values and
implemented through a set o principles, such shared working can be applied among
proessionals on an interdisciplinary and interagency basis and, more importantly, between
proessionals, children, amilies and communities.
Also within this context, there is a need or greater partnership between State services and
the voluntary and community child care sectors. Moving away rom a pure purchaser provider
model to joint working on a reciprocal basis o accountability and joint management will
help lead toward the goal o better services or children and amilies. This requires agencies
and sta to develop and maintain audits o practice through sel-appraisal* processes,
combining agreed practice standards and methods to measure compliance with them.
Although these will be specic to dierent agencies and to dierent sta, there is a set o
10 practice principles that can act as a common underpinning o a shared style o working
or everyone contributing to achieving the 7 National Service Outcomes or Children. These
principles are:
Working in partnership with children, amilies, proessionals and communities.
Needs-led and striving or the minimum intervention required.
Clear ocus on the wishes, eelings, saety and well-being o children.
Refects a strengths-based/resilience* perspective.
Strengthens inormal support networks.
Accessible and fexible, incorporating both child protection and out-o-home care. Facilitates sel-reerral and multi-access reerral paths.
Involves service users and ront-line providers in the planning, delivery and evaluation
o services.
Promotes social inclusion, addressing issues o ethnicity, disability and rural/urban
communities.
Measures o success are routinely built into provision so as to acilitate evaluation.
These principles have currency at individual and agency level, and across ront-line
management and policy contexts. They provide the last piece o the shared approach being
promoted in this document as a means o ensuring that all sta involved in developing
and delivering childrens services are able, by acting together, to maximise their individualcontributions to The Agenda or Childrens Services.
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Section
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One aspect o ensuring that everyone involved in childrens services is pulling in the same
direction is to develop a shared language, one that can be used across the wide range o
occupations and proessions involved. This shared language is not in opposition to the
particular perspectives and specialist terms associated with the dierent occupations and
proessions. It is a basic language or sharing and refecting on how the goals and activities
set out in this document are being developed and implemented.
The terms below have been highlighted throughout the main text o this document as key tounderstanding the way in which Government policy requires services to be developed. Brie
explanations are provided or each, outlining how they are to be understood in the context
o childrens services.
DevelopmentalWelareState: A perspective that sees the goal o State provision as the
development o capacity within individuals, amilies, communities and the economy.
Evaluation: The systematic investigation o the eectiveness o services using social
research methods.
Evidence-basedservices: Those services and interventions that have been developed on
the basis o the best available scientic research evidence.
Familysupport: Activities or amilies that are developmental (e.g. parenting or the rst
time), compensatory (e.g. helping a child cope with a disability) and/or protective (e.g.
ensuring saety o a young person).
Interagency and cross-sectoral working: Proactive coordination o services between
agencies that have their own specic ocus (e.g. health, social care, education or social
welare) and that are located within dierent service sectors, i.e. the statutory, voluntary,
community, not-or-prot and commercial sectors.
Monitoring: The ongoing assessment o services to ensure that they are reaching the
populations they aim to serve and that they are being implemented according to their
original design and to quality standards.
Needs-led: An approach to service development and delivery in which the primary ocus is
always on the physical, intellectual, emotional or social development needs o children.
Outcomes-ocusedapproach: Working towardsachieving an articulated expression o well-
being or children, which provides all agencies with the opportunity to contribute.
Participation: An approach which sees those accessing services as having the right to a
signicant role in the planning, implementation and evaluation o such services.
Partnershipworking: The negotiation and decision-making processes and practices required
by service users and proessionals to achieve ull participation by service users and which
ensure the ull cooperation between agencies in meeting the needs o service users.
Key concepts for
a shared language
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Progressiveuniversalism: A perspective that combines universalism with the targeting o
resources on those that have special needs or support or protection; in other words, help
to all and extra help or those who need it most.
Reectivepractice: Checking and changing practice in the light o learning rom past
experience (refection-on-action) through improvisation during the course o interventions
with and or children and amilies (refection-in-action).
Resilience: Good outcomes or a child and/or or his or her amily in spite o serious threats
to adaptation or development.
Sel-appraisal: A process to sel-audit and monitor worker style and intervention processes
against a set o service/agency standards.
SMART planning: Scheduling work activities that are specic, measurable, attainable,
relevant and time-based.
Social inclusion: Overcoming barriers and reducing inequalities between the least
advantaged groups and communities and the rest o society by recognising the potential o
those who are marginalised and opening up opportunities or that potential to be realised.
Subsidiarity: The decentralised organisation o services with the aim o ensuring that
resources, authority and responsibility are kept as close to the point o their use as
possible.
Targetedservices: Those services that are developed or use by specic subgroups within a
general population or towards a particular area o social need.
Universalservices: Those services that are accessible to all members o a population.
Wholechild/wholesystemapproach: Provision o services in ways that recognise the
extent o childrens own capacities, the multiple interlinked dimensions to their lives andthe complex mix o inormal and ormal supports that they draw upon.
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Usefulpublicationsand websites
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Commission on the Family (1998) Strengthening Families or Lie: Final Report to the Minister
or Social, Community and Family Aairs. Dublin: The Stationery Oce.
Department o Community, Rural and Gaeltacht Aairs (2001) National Drugs Strategy
2001-2008. Dublin: The Stationery Oce.
Department o Health and Children (2007a) Promoting the Well-being o Families and Children:
A Study o Family Support Services in the health sector in Ireland. Dublin: The StationeryOce.
Department o Health and Children (2007b) A Census o Family Support in Ireland: Results
o a census o Family Support Services which were unded by the Health Boards in 2002.
Dublin: The Stationery Oce.
Department o Health and Children (2007c) Family Support in Ireland: Denition and Strategic
Intent. Dublin: The Stationery Oce.
Department o Health and Children (2006a) Disability Act 2005: Sectoral Plan or the
Department o Health and Children and the Health Services. Dublin: Department o Health
and Children.
Department o Health and Children (2006b) A Strategy or Cancer Control in Ireland. Dublin:
The Stationery Oce.Department o Health and Children (2005a) Review o the National Health Promotion Policy
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www.dohc.ie Department o Health and Children
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www.omc.gov.ie Oce o the Minister or Children
Department o Health and Children
www.orygen.org.au ORYGEN is a specialist youth mental health service
in Australia
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www.nda.ie National Disability Authority
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