Family Life - Shine - Performance and Impact Report 2019-20

Performance and Impact Report October 2020

Research, Outcome Measurement & Evaluation (ROME) Unit

Executive Summary 3 Introduction 4 Program Description 5 Methodology 6 Aim of the report 6 Data collection and analysis process 6 Limitations 6 Client Profile 7 Service Delivery 9 How much did we do for our families?

9 Quality of service provision 9 Impact of the SHINE program 12 Case Study: Rosie’s story 17 Families’ voice 18 Conclusion 19 Acknowledgments 19 References 20

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SHINE - Performance and Impact Report | October 2020

Executive Summary

Our mental health enables us to “achieve a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1 Approximately 20% of Australians experience mental ill-health. It has been suggested that mental health promotion, prevention and early intervention strategies may produce the greatest positive impact on people’s health and well-being.2 In January 2008, Family Life commenced the Support, Help, Information Networks and Education (SHINE) pilot project in two Southern metropolitan regions of Melbourne. The SHINE program began as an early intervention and prevention program designed to interrupt the progression of emerging and enduring mental illness for children and young people. Since then, SHINE has provided mental health support in universal and community settings through both outreach and school-based activities.

A previous evaluation of the SHINE program identified that the program increased community awareness and understanding of mental health and wellbeing; improved children’s mental health and wellbeing; family relationships and communication; and children and caregivers learned valuable skills and strategies to support their mental health and wellbeing.3 These findings are supported by this current report.

In addition, the present findings suggest that the program also supports children and young people to be engaged in their community (e.g. school); seek additional support if needed; and assists children and young people to develop self-awareness and selfesteem.

demonstrates our journey in supporting families during the last five years. In summary: • T he SHINE program is a unique service filling a significant gap in the area of children’s and young people’s mental health, supporting clients who do not qualify for more clinical mental health services: 76% of our clients would not qualify for another service due to their age.

• T he key vulnerabilities experienced by clients include poor mental health and limited emotional support, relationship concerns, poor self-esteem and self-worth, difficulty at school; problems with boundaries and behaviour; and the impact of experiences of family violence.

• T he quality of service provision is informed by theory related to trauma, cultural awareness and ecological systems theory. Key successful elements include: assertive outreach, trustworthy mentor/ role modelling, non-clinical and friendly approach, capacity to understand and connect with the children, whole-of-family approach, relevant resources, and a culturally appropriate service.

The program is testament to the rapidly growing body of research highlighting the necessity of intervening early in life, and early in the life of the problem. This is paramount due to the current worldwide impacts of Coronavirus, where modelling suggests that there may be a 25% increase in suicides, and it is likely that about 30% of those will be among young people.4

By using a mixed methods approach to capture the voice of the children, young people, caregivers and practitioners involved in this program, this report

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1 2 3

World Health Organisation (2018) Colizzi et al (2020) McCoy (2012) Bartone, Hickie & McGorry(2020)

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Introduction

Family Life is a specialised child and family services organisation with a well-established footprint across the south eastern suburbs of Melbourne through fifty years of service delivery.

Family Life’s purpose is to support children and young people to thrive by strengthening families and supporting capable communities in order to achieve optimum mental health. Our long connection to the local community has created an extensive network of community partnerships and connections which enhance the mental health and wellbeing of children, young people and families.

Whilst approximately 20% of Australians experience mental ill-health, 40% have never accessed mental health services, with young people less likely than any other age group to seek professional help.5 Over 75% of mental health problems occur before the age of 25.6 We know that among these young people, mental health problems, especially anxiety and mood disorders, are the main cause of disability-adjusted life-years (DALYs)7. Problematic substance use, including alcohol and illicit drugs can accompany mental illness.8

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5 6

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Identifying risk factors and addressing mental health problems early wherever possible (early in life and early in the development of a condition) is key to reducing the social, emotional and financial costs of mental illness.9 The SHINE program supports children and young people during this early stage. The program fills a significant gap in the area of children’s and young people’s mental health, supporting individuals who do not qualify for, or cannot engage with, more clinical mental health services due to age and complexity of issues, where they would otherwise slip through system gaps.

While SHINE has provided mental health support for twelve years, this report provides an overview of the performance and impact of the SHINE program during the last five years - from June 2015 to June 2020.

Australian Government (2019) Kessler et al (2005) https://www.sane.org/information-stories/facts-and-guides/mental-illness-in-younger-people Kelly & Daley (2013) Australian Government (2019)

SHINE - Performance and Impact Report | October 2020

Program Description

“SHINE is unique because it covers the service gap by working with children 0-18; it’s easily accessible; has a focus on early intervention; works with the whole family; and has a unique way of working - environments where the children feel safe and comfortable and friendly for kids.”

SHINE is an early intervention program offering assistance and support to children, families and the community. The program works with children and young people between the ages of 0 and 18 years, and an adult willing to work with them. The program’s objectives are: 10 • T o promote and support mental health in children and young people;

(practitioner focus group participant)

• T o strengthen parenting, relationships and communication within families as a way to promote mental health for children and young people; • T o increase knowledge/awareness of mental health in the community.

The SHINE program’s objectives align with Family Life’s overall purpose of supporting children and young people to thrive through strengthening parenting and relationships within families in the context of building and supporting capable communities.

The service provides individual child and adolescent support, parenting assistance, whole of family support, advocacy and assistance for families, programs and groups work for children in schools and communities, and community capacity building around mental health.

By providing...

Program outcomes - short-term Individual child & adolescent support.

Programs & groups work for children and young people .

Parenting assistance.

Whole of family support.

Advocacy and assistance for families.

Community capacity building.

Children and young people develop skills and strategies to support their mental health & wellbeing.

Children and young people develop self-awareness and self-esteem.

Participants are aware of the dynamics and effects of mental health and wellbeing, and implement strategies to manage mental health and wellbeing issues.

Participants improve their relationships and communication skills.

Children and young people are supported to engage and participate in their community.

Participants seek support (formal or informal) when needed.

Community members understand mental health and wellbeing.

Information gathered from SHINE marketing material

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It will lead to... intermediate

Children and young people use strategies to express themselves and have their mental health needs met.

Families promote mental health and wellbeing for all members (including children and young people).

Participants have healthy relationships.

Children and young people have social support and a sense of belonging within their community and culture.

Children and young people access mental health support.

Communities are supportive of mental health issues.

And ultimately... long-term THRIVING CHILDREN Children and young people experience optimal development and are safe from harm.

STRONG FAMILIES Families experience positive wellbeing and strong and respectful relationships.

CAPABLE COMMUNITIES Adults, young people and children learn and participate within supportive communities.

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Methodology

Aim of the report

Limitations

The aim of this report is to provide an overview of the performance and impact of the SHINE program provided by Family Life. In particular, it focuses on the quality of service provision; the capacity to respond to the complex needs of the children we support; and the extent to which the program achieves its overall objectives.

While the methodology aimed to capture the perspective of a diverse group of stakeholders, limitations need to be acknowledged and should be considered when reading this report:

Data collection and analysis process A mixed methods approach, combining a range of qualitative and quantitative methods, was used to obtain a detailed picture of the SHINE program and allow for triangulation of information to confirm and support findings. 11

• Participant feedback survey: Response rate 28%; • I nternal families progress reports: The level of depth was limited to the data available; and data outside the period reviewed are not included in this report; • O utcomes Measurement tools: Data compares progress at the beginning and at the end of the service which is not the same for each family; • F ocus groups, interviews, case study and documentation review: Possibility of bias is acknowledged regarding participants’ own involvement in the service and the qualitative nature of the data.

Descriptive analysis of monitoring data: July 2015 to June 2020 (n=902 including primary client and relatives working with the primary client)

Content analysis of internal families progress reports: July 2019-March 2020 (n= 103)

Documentation review: Includes funding requirement reports and previous evaluation reports

Descriptive and statistical analysis of outcomes measurement tools: Family Star Plus (n=31 - period Feb 2017- June 2020 - with parent as child is too young 0-5 years)

Descriptive analysis of participant feedback survey: July 2015 to June 2020 (n=227 from children, young people, and adults).

Thematic analysis of interviews with families: July 2020 (n=5) Thematic analysis of focus groups with practitioners: July 2020 (n=6)

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• Monitoring data: Sample size varies per variable;

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My Star (n=337 - period June 2015 June 2020 with children 6-12 years) Youth Star (n=63 - period Nov 2015 June 2020 with teenagers 13 and over)

Case study: Seven case studies provided by the SHINE team were analysed using the most significant change methodology to select the story to be included.

Triangulation refers to the practice of using multiple sources of data or multiple approaches to analysing data to enhance the credibility of a research or evaluation study.

SHINE - Performance and Impact Report | October 2020

Client Profile

Since 2015, the Family Life SHINE service has provided support to

51%

77% 902 individuals

female

of those who received any type of support were under the age of 18. The rest include the broader family members.

(608 children and young people as primary clients and 294 family members).

49% male

Age Profile

8%

24%

Less than 5

13 to 18

31%

13 to 18 Primary client n=602

31% 5 to 8

37%

22%

9 to 12

12%

9 to 12

Less than 5 Sibling or family member related to the primary client n=89

34% 5 to 8

20%

More than 45

1%

19 to 25 Older members of the family n=205

46%

34%

26 to 35

36 to 45

Around two thirds of SHINE clients are under the age of 13. Without SHINE, they would not be able to access other mental health services.

Our families come from 29 mainly located in the City

Dandenong (36%).

different suburbs on the south-east side of Melbourne; of Casey (57%); and the City of Greater

These areas are within the top 3 areas in Victoria with the largest population of people born overseas and Language Other Than English Speakers with low English proficiency.12

According to the Victorian Government (2018) report, 57.7% of the population in the City of Greater Dandenong was born overseas and 38.2% of the population in the City of Casey was born overseas.

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Vulnerabilities Families are referred to the SHINE program mainly for mental health support. Primary support needs identified in the internal family progress reports13 include:

Mental health and emotional support

(72%)

Boundaries and behaviour issues

(29%)

Relationship concerns

(39%)

Physical health and wellbeing

(24%)

Poor self-esteem and self-worth

(37%)

Community support and access to support services

(17%)

School issues

(30%)

Family violence experiences (current or past)

(14%)

This data is confirmed by the monitoring data (n=705) which suggest that the primary reason for 83% of the clients referred is mental health assistance. Other reasons for referral include support regarding family functioning, education, age-appropriate development, community participation and networks, and physical health.

Complexity of issues While the majority of children and young people come to our SHINE service mainly due to mental health concerns and emotional support, the internal family progress reports review suggests that they have multiple and complex needs; 55% have at least 3 support needs and 45% have between 1 and 2 needs.

This was confirmed by practitioners during the focus group who identified that the intensity and complexity of cases is increasing. This requires longer and more intensive work with multiple family members. As a result, very few referrals turn out to be short-term clients (6 sessions or less), with many more becoming long-term intensive clients.

“As we work with a whole-of-family approach, we can understand and address the whole family dynamics as this impacts our client wellbeing.” (practitioner focus group participant)

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An example of a child accessing the SHINE service with more than 3 needs: Relationship concerns <Robie> advised his relationship is not good with his siblings.

Emotional support: <Robie> advised: “I have difficult feelings and I don’t know how to manage difficult feelings.”

School issues: Learning is difficult for <Robie> because English is his second language and they arrived in Australia a few months ago.

Boundaries and behaviour issues: Aggressive behaviour towards siblings. <Robie> stated: “I get aggressive very quickly and I don’t know how to calm down.”

Self-esteem, self-worth and confidence: <Robide> advised he is confident to talk in front of others but he gets anxious.

Community support: <Robie> stated he has few friends but he doesn’t want to make new friends.

13 Notes related to primary support needs were coded using an inductive approach. Families who received, or are still receiving, support during the period between July 2019- March 2020 were included in the analysis (n=103).

SHINE - Performance and Impact Report | October 2020

Service Delivery

How much did we do for our families?

From July 2015 to June 2020 we have provided…

10,267

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hours of support to our families

hours per primary client (on average)

Time in the service

1357

sessions families at a location different from the office

contacts using email, phone messages, video conferences, ormail/post

476

2397

sessions with families at the office

calls

n= 797

41% 44% 15%

less than 3-6 3 months months

4242

More than 2 years

“I discuss with parents about their culture, to learn about their culture, history, background, everyday routines. This gives me a better understanding of what I should be doing.” (practitioner focus group participant)

Around 30-40% of SHINE clients are from a Culturally and Linguistically Diverse (CALD) background. Supporting CALD communities has its challenges such as language barriers, cultural differences and beliefs about mental health. To support clients with a CALD background, practitioners have an open communication strategy to understand clients’ cultural needs and background; undertake self-reflection exercises to question their own beliefs and bias and debrief in supervision and team meetings. They also help their clients understand the Australian culture, explain key concepts around mental health and support clients to access services.

Quality of service provision Family Life’s SHINE practice framework is grounded in principles of trauma-informed practice and an ecological approach. SHINE uses evidence-based individual and group activities to enhance and compliment the case management work provided for children, and the program builds partnerships with schools and other agencies, and strengthens community engagement.

“<The worker> definitely took into account our cultural needs, we’re Middle Eastern Australian. <The worker> is really quite considerate and caring.” (interview with a caregiver)

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Trauma-Informed Practice: We know that the risk of developing mental health problems increases in line with the number of adverse childhood experiences encountered by our clients.

Family violence, exposure to a carer’s own mental illness, and experiences of abuse and neglect all constitute adverse experiences with the potential to contribute to traumatisation and emerging mental health problems.14 This report highlights the complex range of issues experienced by clients in the SHINE program which requires a trauma informed approach to practice.

Skills building (64%) “The different strategies that <the worker> has helped <Angie> and I to communicate better.” (parent)

Trauma informed Practice is a strengths-based framework founded on five core principles – safety, trustworthiness, choice, collaboration and empowerment.15 Adopting a trauma-informed practice in mental health support services aid the recovery of people in care, reduce the potential for retraumatisation, and promote a more collaborative and empowering care environment.16 Internal families progress reports notes and qualitative data from children, young people and caregivers surveys provide information about how traumainformed practice and the ecological approach are enacted with clients.17

Strength-based approach (16%) “<The worker>draw my son attention and focus on the positive side and strength points in his character rather than giving in to what has been diagnosed.”

Understanding client needs (8%) “The SHINE worker listened, while understanding demands of tending to 3 ASD children, their emotions and needs.” (parent)

(parent)

Self-regulation, self-control and coping strategies (60%) “<My worker> helped me to manage and control my anger.” (child)

Positive attachment (5%) Education/information provided (14%) “She helped me by telling me the best way to stop bullies is by just smiling and ignoring them.”

Empowerment and support (30%) “<My worker> gave me hope for getting through life and life’s problems.” (young person)

“Provide opportunity and modelling for <Charlie> and his parents to interact in warm and caring ways.” (practitioner)

(young person)

Self-care strategies and creating safety (13%) “<The worker> informed client his parents would need to be notified of such activities due to potential self-harm and potential harm to others.”

Some of the techniques used in the service include: Cognitive behavioural therapy, motivational interviewing, mindfulness, transactional analysis, and play therapy.18

(practitioner)

Harvard Women’s Health Watch (2019) https://mhaustralia.org/general/trauma-informed-practice 16 https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/safety/trauma-informed-care 17 Internal families progress reports notes (n=92) of the July 2019-March 2020 period related to the strategies we use to support our clients were coded using a deductive approach following key elements of trauma-informed service delivery (Wall, Higgins & Hunter, 2016).

18 As a response to the disruption caused by COVID-19, Family Life has been conducting weekly safety planning with clients to mitigate risk.

From the week starting on the 6th of April until the end of June 2020, there have been 202 contacts with families; this represents on average, 17 families being contacted weekly. This is in addition to the regular sessions which have been held by video-conference.

14 15

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SHINE - Performance and Impact Report | October 2020

An Ecological Approach: An ecological theory forms one of the core theoretical underpinnings of the SHINE model. This is lived through strong partnerships which brings together key parts of the system to provide connected and quality services.

“We work in an environment where kids feel safe (school, home, a park, Mcdonalds). In other services, they have to go into a clinical environment. This is frightening and intimidating for them. SHINE eliminates that barrier.” (practitioner focus group participant)

Group activities

Assertive outreach- 90% of the face to face contact occurs in the children’s environment

Interagency & collaboration & referrals (45%)

Encouragement to participate in community/ social activities (17%)

Act Up: To promote personal growth, positive emotional and psychological health, selfesteem, confidence, resilience and social networks through film, drama and theatre (for children 8-14 years of age).

Map Your World: To inspire students to look around their school and local community to identify gaps/areas for improvement and ways to do it (classroom of students aged 9-10 years - diverse range of multicultural and socioeconomic backgrounds).

Fun Friends: A six week program, run in collaboration with school and early learning centres to develop coping skills, social skills, and resilience through play (children aged 4 and 7-8 years).

RUOK? Day: Yearly RUOK? Day morning tea organised by SHINE for the staff at Doveton College to acknowledge their hard work, encourage them to look out for each other, and to provide relevant resources.

Time to SHINE: To address student anti-social behaviour and school bullying by improving communication and social skills; encouraging healthy behaviour; developing and enhancing positive relationships (children aged 8-12 years).

Peaceful Parenting: A two day workshop for parents experiencing challenges in the parenting role. Focuses on attachment styles; selfawareness and emotional self-regulation skills; role modeling; understanding challenging behaviour; and skills to support their child to further develop and grow.

Friends for Life: A social skills and resilience building program to prevent anxiety and build resilience recognised by the World Health Organisation (for children aged 8 -11 years).

Unstoppable Me: It teaches children - in a fun way about mental illness, how they can respond to their parents who are experiencing a mental illness episode with confidence and understanding (for children aged 10-14 years who have a parent with a mental illness to reduce their own feelings of anxiety and fear).

Parenting Under Pressure: This program supports parents in maintaining their own well-being.

Strategies used to support our clients

An example of a family supported by SHINE

From July 2019 to March 2020, 40% of our families were using more than five strategies: supported using at least two different strategies; 48% were supported using three or four strategies; and 12% were Skill building: <Omar> Empowerment and support: supported using more than five different strategies. 19 practiced self-esteem exercises.

Encourage and motivate Interviews with caregivers suggest that SHINE is a unique program as mental health services for children or young people are limited or non-existent. For them, key features of the program include: assertive outreach, mentor/ role modelling for the children, non-clinical and friendly approach, capacity to understand and connect with the children, whole of family approach, relevant resources, and culturally appropriate service.

“She taught me a lot about dealing with his anger. Taking things a bit calmer and not making a big deal of some things. There is a lot of calmness and peace in the family now.” (interview with a caregiver) 19

Internal families progress reports notes review

Education/information provided: Provide basic education on mental health and benefits of mental health support.

Understanding client needs: Search for potential career paths, identify interests and guide education/skill development.

Self-regulation, self-control and coping strategies: <Omar> learned positive thinking.

Writer promoted client’s selfawareness and encouraged positive self-talk.

<Omar> into mental health services.

Opportunities for truth telling: Writer informed <Omar’s> mother the concerns of mental health issues. Writer helped the mother understand some of <Omar> reasons for not going to school.

Interagency collaboration & referrals: <Omar> is now involved with specialised mental health service, CGD Family Services and Navigator program.

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Impact of the SHINE program

What would be the risk for vulnerable children /young people not having the support of a program like SHINE? During the Focus Group, practitioners identified that without the support of the SHINE service, children and young people would potentially be negatively impacted in the following ways:

Children and young people would be lost (e.g. using drugs)

By the type they would be picked up by services, they would have higher and more complex issues

“I don’t think there’s anything like it. Mental health services for young people are very restricted, I’ve never heard anything like SHINE in the southeast of Melbourne.” (interview with a caregiver)

Risk of criminal activity

75% of young people

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Problems within the family would not be identified

reported achieving mostly or all their goals during the service.

An example of an young person with four outcomes supported by the SHINE service

36% completely achieved their goals

39% mostly achieved their goals

25% somewhat achieved their goals

Improved behaviour and boundaries: <Rhys’> mother has reported a change in <Rhys’> behaviour (appearing to be less angry and more capable of handling his anger in appropriate ways) as well as becoming less triggered by his father (past trigger).

Self-esteem and confidence improved: <Rhys> has reported feeling more confident in this domain.

Participation in community/group activities: <Rhys> is linked in with a structured play group which at school which he attends at lunch time.

Using learnt strategies: <Rhys> and the writer have explored and implemented various strategies to promote emotional regulation and to manage intense feelings of anger. <Rhys> has advised that he feels as though he is capable of implementing discussed strategies and managing his anger. <Rhys> has advised that he implements deep breathing, relaxing music and utilising the stress ball which was made by himself and the writer as well as various other relaxation techniques.

12 Goal achievement was identified through the Young people survey (n=36). Example of outcomes was identified in the internal families progress reports notes

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SHINE - Performance and Impact Report | October 2020

To understand the impact of SHINE, different methods21 were used. Triangulation22 of the data was done to confirm and support the findings. These are presented based on the program’s objectives.

Legend Documentation Review

Outcomes Star data

Quantative analysis of internal families progress report

Focus groups with practitioners

Quantative data from child and young people surveys

Interviews with caregivers

Children and young people develop skills and strategies to support their mental health & wellbeing

Improved wellbeing

Manage feelings and emotions (22%)

Improved behaviour and boundaries (28%)

Using strategies to deal with challenging situations (32%)

(26%)

Improved feelings and emotions (26%) Using emotional regulation learnt strategies (24%)

Changed perspective/ life-direction (10%) Improved behaviour

(8%)

“We provide education about emotions, particularly those that are hard to manage, providing clients with tools and strategies to manage these issues when they don’t have worker involved”

“My daughter is able to regulate a little bit better - It helped her understand her emotions and where they are in her body” “His behaviour has improved so much. He doesn’t trash anything anymore - he used to break everything”

My Star (Children) There was a median increase from 3 (‘trying’) to 4 (‘finding what works’) in the “Feelings and Behaviour” domain (scores at the beginning and at the end of services were statistically different (p=0.000)). In total, 57% of children experienced a positive shift. At the end of the service, 71% of children scored a 5 or a 4 (‘resilient’ or ‘finding what works’). This represents a 32% increase from the commencement of the service. *There was also a statistically significant difference between the beginning and the end in a similar domain of the young people’s instrument (‘Choices and Behaviour’ p=.012)

Content and thematic qualitative analysis of internal families progress report (n=106), survey children and young people qualitative data (n=128), focus group with practitioners (n=6), interviews with caregivers (n=5) Descriptive and statistical analysis using the sign test of the outcome measurement tools data: My star: children (n=225), Youth star: young people (n=43), Family star plus: caregivers (n=20) 22 Triangulation refers to the practice of using multiple sources of data or multiple approaches to analysing data to enhance the credibility of a research or evaluation study 21

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Children and young people develop self-awareness and self-esteem

Improved self-esteem and confidence (31%)

Improved confidence

(13%)

“Client with very violent thoughts and intentions.

I showed him his good side and talked about benefits rather than punishments. I also educate the family on how to treat him”

“Her self-esteem improved. She is a very strong girl”

My Star (Children) There was a median increase from 3 (‘trying’) to 4 (‘finding what works’) in the “Confidence and selfesteem” domain (statistically significant difference (p=0.000)). In total, 54% of children experienced a positive shift.

At the end of the service, 77% of children scored a 5 or a 4 (‘resilient’ or ‘finding what works’). This represents a 33% increase from the commencement of the service.

Participants (family members) are aware of the dynamics and effects of mental health and wellbeing, and implement strategies to manage mental health and wellbeing issues

Understanding children’s needs and behaviours (7%)

“The mother of this client used to drink a lot, this was a trigger to him and made him very angry. He had violent thoughts. We talked to the family and explained the situation.

We try to help the parents”

“My daughter can also see me trying to support her despite my own mental health struggles”

Family star plus (caregivers) There was a median increase from 7 (‘finding what works’) to 9 (‘effective parenting’) in the “Boundaries and Behaviour” domain (statistically significant (p=0.004)). In total, 70% of individuals experienced a positive shift.

At the end of the service, 65% of individuals scored a 9 or 10 (‘effective parenting’).

This represents a 40% increase from the commencement of the service.

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SHINE - Performance and Impact Report | October 2020

Participants improve their relationships and communication skills

Improved communication skills and relationships

(24%)

Made friends and improved relationships

(11%)

“A 7 years old boy was put into the care of grandparents due to parents’ incapability. The boy didn’t understand why and started blaming his grandmother. His behaviours were getting very challenging. In a child-friendly manner the practitioner explained the situation to the kid...From there, his behaviour got better and stopped blaming the grandmother: ‘you didn’t take me away from parents, the judge did’”

“She loves to cook and before I would try to help and she would walk away and cry. Now, she goes away for 5 minutes and comes back and hugs me, apologises and acknowledges what made her upset”

Youth Star (young people) There was a statistical difference in the scores at the beginning and end of service (p=0.003) in the “Communication” domain.

At the end of the service, 74% scored a 5 or a 4 (‘enjoying and achieving’ or ‘working on it’).

This represents a 21% increase from the commencement of the service. *There was also a statistically significant difference in the scores of similar domains of the children’s instrument (‘Relationships’ p=.000) and (‘Friends’ p=0.000)

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Children and young people are supported to engage and participate in their community

Participation in education / school issues resolved

(24%)

Improved school issues / learning (8%)

Participation in social / community activities

(7%)

“This client used to spend all his money on gambling. I referred him to gambling helpline, and supported him to complete VCE during case management. Now he is enrolled in Chisholm to be an electrician”

“In school he was like a zombie. He never smiled, nor participated in school activities. Now I got videos and photos of him running with his friends around the school - he is doing very well. He is reading everything. He couldn’t read his name”

Youth Star (young people) There was a statistical difference in the scores at the beginning and end of service (p=0.031) of the “Education and work” domain.

At the end of the service, 72% of young people scored a 5 or a 4 (‘enjoying and achieving’ or ‘working on it’). This represents a 16% increase from the commencement of the service. *There was also a statistically significant difference in the scores of a similar domain of the children’s instrument (‘Education and Learning’ p=.000)

Participants seek support (formal and informal) when needed

Accessing care

(28%)

“Now we are seeking formal assistance - my son would not have communicated that issue to us”

Practitioners mentioned several services to which their clients have been referred for further support (e.g. headspace, SECASA, Child protection, pediatrician, psychiatric, helplines, GP, material aid).

“While working with a client I realised that his older brother also had some issues. So, I started engaging with him and referred him to a psychiatric service. They diagnosed him with psychosis and now he is in hospital receiving support”

Community members understand mental health and wellbeing SHINE is actively involved in the community. Yearly, the SHINE team organise and/or attend around 12 relevant events based on mental health, wellbeing, family violence and multicultural communities.

For example, SHINE organises the Circus Skills workshops to build relationships between children and caregivers. The SHINE team takes part of the Afghan/Persian New Year festival and provides material to the more than 10,000 attendees.

SHINE has had long term formal partnerships with community services and educational institutions including the Southern Migrant and Refugee Centre, Life without Barriers, Headspace, Doveton College and Tooradin Primary School.

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To reach out to some of the main community groups, SHINE has translated its brochure in Persian (Dari and Hazaragi), Arabic and Tamil.

SHINE - Performance and Impact Report | October 2020

Case Study: Rosieâ&#x20AC;&#x2122;s story23

Rosie is a 11 year old girl who was referred to the SHINE program due to experiencing trauma pertaining to a significant involvement with the Child Protection system as well as exposure to family violence. Rosie has reportedly previously experienced bullying which contributed to disengagement from school.

Additionally, Rosie was experiencing issues with regulating her emotion. Rosie was reluctant to engage in any type of support service and initially stated that she did not want to work with SHINE, however would attempt to engage.

Emotional awareness activities and strategies which encouraged recognition of physical signs of anger in the body as well as strategies and tools to regulate anger when triggered.

How did the SHINE program support Rosie?

After collaboratively completing the Youth Star assessment with the practitioner. Rosie was able to identify that she was struggling with issues of selfesteem as well as difficulty regulating her emotions, in particular anger. The practitioner used an array of theories and approaches when working with Rosie and her family to address her emotional concerns and lack of self-esteem including:

Exploration of various relaxation and mindfulness techniques such as guided meditations, breathing exercises and visualisation.

Positive self-talk and selfacceptance using various Cognitive Behavioural Therapy techniques to promote an increase in self-esteem.

Assisting and supporting Rosie to identify further tools to assist in emotional regulation which Rosie identified to be physical activity such as going for walks or listening to relaxing music.

The exploration of organised community group activities for which Rosie could participate in after school and build friendships, networks and selfesteem.

What did Rosie achieve?

Upon completing ten sessions, Rosie reported she felt she was becoming less triggered by situations and instances that would previously cause her to heighten and escalate emotionally. In addition, she stated that when she did become triggered, she felt confident in implementing strategies that were collaboratively created by Rosie and the practitioner. Rosie enrolled in school despite previously being adamant that she did not want to attend school and that school wasnâ&#x20AC;&#x2122;t for her. Rosie gradually increased her hours of attendance and displayed a high level of motivation to maintain and improve her learning. Rosie was nominated for and won an award as part of her council Youth Services Team awards for her resilience and ability to overcome adversity.

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Note: Names and identifying details have been changed

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Families’ voice From July 2015 to June 2020, 227 client feedback surveys were received from children (n=119), young people (n=68), and adults (n=41) involved in the SHINE program.

Children

96%

My worker listened to what I had to say

94%

I like having the worker come to visit

83%

If needed, I would come to SHINE for help again

“The most important thing was that he helped me manage and control my anger and that helped the family as well.”

Young people

95%

The SHINE worker respected me and was supportive of me

93%

The SHINE worker was able to communicate well with me

90%

The SHINE worker listened to me and was flexible

75%

I would come back to Family Life if they require support in the future

“What was helpful was talking to me and getting to know me well so I can feel comfortable and deal with my fear.”

Adult

90%

The service listed to me and my family, and understood our needs

“I think our SHINE worker went above and beyond - met at very turmoil times for this family with recent separation taking place. The SHINE worker listened, while understanding demands of tending to 3 Austim Spectrum Disorder children, their emotions and needs.”

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SHINE - Performance and Impact Report | October 2020

Conclusion The SHINE program is a unique program which provides targeted and early mental health intervention to children, young people and their families, through a whole-of-family service approach. The current evaluation demonstrates that the service has provided support to children and young people with complex mental health and wellbeing issues. Key aspects of the success of this program include using techniques such as Cognitive Behavioural Therapy, motivational interviewing, mindfulness, transactional analysis, and play therapy. From the families’ perspective, important elements include: assertive outreach, mentor/role modelling for the children and young people, the non-clinical and friendly approach, practitioners’ capacity to understand and connect with the children and young people, the whole of family approach, the relevant resources provided, and the culturally appropriate service provided. Integral to the program efficacy has been staff experience in the provision of these services for children and young people.

The findings suggest that the SHINE program has achieved its objectives. Children, young people and families are using strategies to support their mental health and wellbeing. They enjoy improved relationships in supportive communities. Almost all families are satisfied with the service provided.

This program is particularly relevant as there are limited services supporting children and young people and mental health concerns are growing rapidly and are appearing before a young person turns 14.

This suggests a much larger increase in the number of mental health presentations in adults in the future,24 if this is not managed early in life and in the development of the problem.

Future Directions Future funding should enable the continuation of this service and the scaling of the SHINE program to other regions. The service model has demonstrated efficacy with a diverse client cohort suggesting reliable outcomes through expanded service delivery. Mental Health services risk over clinicalisation, reduced community accessibility and siloed service responses.

The SHINE service has demonstrated the impact of systems oriented practice. Policy should highlight the role of evidence informed family centred practice as mental health intervention. The family services workforce should prioritise mental health training and practice adjustment. This would enable earlier mental health intervention within currently funded family services creating greater reach and economic efficiency. The SHINE program offers a conduit to such an approach.

Acknowledgments Family Life’s Research, Outcome Measurement and Evaluation (ROME) team would like to acknowledge the support and contributions made to this report: • T he SHINE clients who participated both during the surveys and interviews, for so generously giving their time and sharing their personal experiences.

Family Life acknowledges the bravery, determination and ability to drive change that has presented in those we serve during their SHINE journey.

• T he SHINE practitioners for contributing to data collection and measuring outcomes, for being transparent and honest during the team focus group, and for being very caring with all the families they support.

• T o the Founder - The Department of Social Services - and the Leadership group for their commitment to such a necessary service.

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https://www.abc.net.au/news/2020-07-20/youth-mental-health-emergency-departments-study/12461190

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Bartone, T., Hickie I., & McGorry P. (2020), COVID-19 impact likely to lead to increased rates of suicide and mental illness. Retrieved from https://ama.com.au/ media/joint-statement-covid-19-impact-likely-leadincreased-rates-suicide-and-mental-illness

Kessler, RD et al. (2005), Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry, 62, 593-602

Colizzi, M., Lasalvia, A., Ruggeri, M. (2020), Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?, International Journal of Mental Health Systems, 14 (23), 1-14, doi.10.1186/s13033-020-00356-9 Harvard Women’s Health Watch (2019), Past Trauma may haunt your future health. Harvard Health Publishing. Harvard Medical School. Retrieved from: https://www.health.harvard.edu/diseases-andconditions/past-trauma-may-haunt-your-futurehealth

Family Life 197 Bluff Road Sandringham, Victoria Vic 3191 Phone: +61 3 85995433 Email: info@familylife.com.au www.familylife.com.au

McCoy, A. (2012), What about children’s mental health?

An evaluation of the Family Life SHINE children’s mental health pilot projects, Family Life Victorian Government (2018), Population diversity in Victoria: 2016 Census Local Government Areas, The State of Victoria, Department of Premier and Cabinet Wall, L., Higgins, D., Hunter, C. (2016), Trauma-informed care in child/family welfare services, Child Family Community Australia, CFCA Paper No. 37 World Health Organisation (2018), Mental Health: strengthening our response. Retrieved from https://www.who.int/news-room/fact-sheets/detail/ mental-health-strengthening-our-response

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