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Risk Management Literature Review

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									UPDATING THE LITERATURE AND
EVIDENCE ON INTEGRATED
APPROACHES – ACT TURNAROUND
PROGRAM




                   A LITERATURE REVIEW




        Morgan Disney and Associates Pty Ltd
                                  AUGUST 2005
                                                CONTENTS



  Executive summary ......................................................................................... 3

  Background ..................................................................................................... 4

  Method ............................................................................................................ 4

  Fragmentation, complexity and integration ..................................................... 4

  Collaboration ................................................................................................... 5

  Tiered support ................................................................................................. 7

  Other “essential” ingredients for integrated case management ..................... 11

  References .................................................................................................... 13

  Appendix: Turnaround Literature Review (June 2004) SUMMARY............... 15




Literature review update on integrated governance and approaches                                                     2
MorganDisney & Associates
August 2005
Executive summary
This literature review summarises recent work in the area of integrated case
management and approaches and provides both an update on the literature and the
practice issues. This work forms part of the advice provided to the Turnaround
Management Committee by the Research and Evaluation Consultancy Team. Drawing
on information stemming from the academic and program evaluation literature, it
identifies four main themes:
   Fragmentation, complexity and integration: Acknowledgment that an integrated
    approach to service provision and support for young people at risk is the most
    suitable due to (a) the problematic and widespread fragmentation of service
    provision, and (b) the inter-domain, multi-issue complexity of the situations of young
    people at risk. Contrasting opinions – that interagency “joined-up” services are
    leading to de-professionalisation of workers and an increased culture of
    managerialism – are also explored.
   Collaborative work: Literature which explores these integrated approaches to
    supporting young people at risk and their families – with a focus on inter-agency
    and team work as well as collaborative partnerships between the government and
    non-government sectors. In particular exploring a model which identifies key
    features of collaborative inter-agency team work in the provision of support for
    young people at risk.
   A “tiered” team framework: Multi-level team-based support for young people at risk
    and their families – the team that directly support the young person and their family;
    the team that address organisational and cross-systems issues; and the team that
    address policy and regulatory systems – and the necessary conditions that these
    different level teams must foster to enhance the hands on service provision
    provided to young people at risk.
   Other “essential ingredients” of integrated case management for young people at
    risk: Primarily reinforcing themes present in June 2004 Literature Review, (for
    example, integrated case management is implemented within the context of an
    individualised, strengths-based, family centred approach, with flexible funding,
    strong partnerships). Supplemented with reflections on what is now over a decade
    of integrated service provision within the Wraparound framework. Also with a
    developing focus on establishing an empirical base correlating creative team
    processes with effective individualised planning.




Literature review update on integrated governance and approaches                        3
MorganDisney & Associates
August 2005
Background
This literature review supplements the Background Research and Literature Review for
the Turnaround Program (June 2004) which is summarised in the appendices, and
identifies new key themes in the literature related to integrated case management for
young people at risk. It also builds on the literature review provided in October 2004 on
youth participation and working with families. New literature has been identified and is
drawn from a series of program and governance evaluation reports, Wraparound/ISP
(Individual Support/Service Planning) literature, and academic literature focusing on
collaborative alliances. Many of the themes discussed in the June 2004 Literature
Review are strengthened and supported by the new literature, and are summarised
here in addition to the new themes identified.

Method
Through a search of the international literature – both published academic literature as
well as descriptive and evaluative literature available in the public domain – three
distinct streams of literature were identified and incorporated into this review.
     Program and governance reviews (primarily drawn from the Centre for
         Governmental Research, New York).
     Wraparound / ISP literature.
     Academic literature about collaborative alliances from a broad range of human
         service and business sectors.

Fragmentation, complexity and integration
Two key factors led to the current emphasis on integrated approaches to providing
services and support for young people at risk (Berson, Vargo, Roggenbaum, 2003;
Pryor, 2002; Rosenkrantz, 2003):
a) the common and problematic widespread nature of service fragmentation,
b) the inter-domain, multi-issue complexity of the situations of young people at risk.

          It is our contention that a multiagency service delivery model should mirror the
          multidomain presentation of these youth and overcome agency „silos‟ (Lee,
          Dillon, Dorries, Beech & McDermott, 2004, p. 266).


The situations of young people at risk may be exceptionally complex. Support needs
may be multiple and may exist across a number of domains, such as housing, justice,
health, disability, and family support. Such complex situations require matched
responses, which are increasingly demonstrated through integrated multi-agency
approaches



    Collaboration has the capacity to empower and connect fragmented systems for the
    purposes of addressing multifaceted social concerns (Gajda, 2004, p.66).



However, service fragmentation continues to prevent a holistic approach to supporting
young people at risk and leads to a number of negative outcomes including, for
example (Meridian Consulting Services, 2002; Pryor, 2002):
     increased possibility of service gaps,


Literature review update on integrated governance and approaches                             4
MorganDisney & Associates
August 2005
   poor information sharing, with workers in one area, or “silo”, unaware of what is
    available in other areas, and
   high administrative burdens as young people are required, for example, to
    undertake numerous assessment and intake processes as they access the wide
    range of services.
An integrated approach to addressing problems of complexity and fragmentation is
demonstrated in both the academic and service evaluation literature. For example:
   A small, but growing literature base supports positive and more cost effective
    (particularly in comparison to out-of-home placement) outcomes of integrated case
    management (see for example Berson, et al., 2003; Potter & Mulkern, 2004;
    Rosenkrantz, 2003).
   In the Tioga County in New York State, Meridian Consulting Services’ (2002)
    recommended the creation of a single Department for Children, Youth and Families
    – with a central intake, “integrated” service coordinator positions, a common
    assessment tool and protocol, integrated data management system and a multi-
    disciplinary assessment process – in response to the identified fragmented service
    system.
   Rosenkrantz (2004) recommended the establishment of a County Health and
    Human Services Cabinet – a forum for open and frank discussion of issues, cross-
    systems planning, resource-maximising strategy development, and best-practice
    information sharing – in an attempt to provide integrated services.
   Lepler & Rosenkrantz (2003), in their work with the Erie County to develop a more
    coordinated and responsive service system for young people at risk, recommended
    the creation of a Department for Children, Youth, and Families.


There have been some criticisms of this push for integration from researchers who
argue ulterior motives; these criticisms are occasionally also voiced in human services.
Burnett and Appleton (2004)for example argue that while there are some positive
aspects of collaboration in the provision of services for young people at risk (they
review the Youth Offending Teams in the UK), they also view “joined-up” (interagency)
support models as “the corporate approach [and] as evidence of the further
encroachment of a monolithic and repressive state power” (p. 35). These authors
believe that interagency models have been “instrumental in the systematic de-
professionalisation of criminal justice staff and have engendered a culture shift from
welfare-based, direct work with young people to a more removed managerial system
concerned with performance monitoring and cost-effectiveness” (p.36). However the
evidence which justifies this claim is missing in the literature and is very questionable in
the face of evidence of good client outcomes in other research.


Collaboration
In response to the understanding that integrated approaches are generally the most
appropriate ways of supporting young people at risk and their families, the literature
also explores methods of collaboration. There is a focus on inter-agency and team
work, as well as partnerships between government and non-government organisations.




Literature review update on integrated governance and approaches                          5
MorganDisney & Associates
August 2005
      The June 2004 Literature Review highlights key themes about collaborations from the
      pioneering work of Gajda (2004):
          Collaborations have many faces and exist on a continuum from one-off cooperative
           efforts to long-established integrated alliances.
          Collaborations pass through many stages.
          Personal relationships – particularly ones with a high level of trust – are as important as
           formal procedures in collaborations, particularly where collaborations aim to develop
           innovative solutions to complex problem situations (see also Das, 2002; Hattori &
           Lapidus, 2004; and Vangen & Huzham, 2003)




  Walker and others (see Walker, Koroloff & Schutte, 2003; Walker & Schutte, 2003,
  2004) – in their writings which explore team work in the Wraparound/ISP process –
  have developed a collaborative inter-agency team practice model. This model
  identifies the what the authors consider to be key aspects of collaborative team work
  which lead to high quality services for young people at risk. These key factors are:
         The team inputs: e.g. team member skills, knowledge and background;
          organisational and system support.
         The team practices: e.g. the techniques and procedures for developing and
          prioritising goals, sharing information, gathering feedback, ensuring a family/client
          centred and strengths-based approach, etc.
         The team planning processes: e.g. how the team defines its goals and mission;
          generates solution options, and continually evaluates itself.
         The team cohesiveness: e.g. how the team works towards shared common values,
          fair and effective decision making procedures, and mutual respect.




                                             ISP Team Processes

                                             Planning. The planning process
                                             prioritizes family/youth perspective
                                             and includes attention to
                                              Defining team mission and goals
                                                with associated strategies and
                                                performance criteria.                  ISP Outcomes
                                              Exchanging information,
                                                broadening perspectives, and           Team achieves
ISP Inputs            ISP Practices
                                                generating multiple options before     appropriately ambitious
                                                making decisions.                      goals in a manner
Team                  Specific
                                              Continually evaluating and revising     consistent with the ISP
member                techniques and
                                                goals and strategies.                  value base.
background,           procedures for
knowledge,            making                                                           Increased coordination
and skills            decisions,                                                       between
                      defining goals,                                                  services/supports
Organization          ensuring family        Building cohesiveness. Team members
                                             build shared perceptions that             and needs
and system            centeredness,
support               building on             Team members hold goals and
                                                                                       Supportive and
                      strengths, etc.          values in common, including the
                                                                                       adaptive relationships
                                               values associated with ISP
                                               (cooperativeness).
                                                                                       Increased family
                                              The team can be effective and ISP
                                                                                       empowerment and
                                               is an effective intervention
                                                                                       quality of life
                                               (efficacy).
                                              The team follows fair procedures
                                               during discussion and decision
                                               making (equity).
                                              Team members are respected,
                                               even when they disagree or make
                                               mistakes (psychological safety).

  Literature review update on integrated governance and approaches                                       6
  MorganDisney & Associates
  August 2005
Collaborative partnerships occur not only within government departments and
agencies, but also between government and non-government sectors (including both
not-for-profit and for-profit organisations). The literature recognises the significant
importance of including all stakeholders in collaborative relationships and highlights the
benefits of involving these various sectors (Pryor, 2002; Wohlstetter, Malloy, Hentschke
& Smith, 2004).
The identified benefits of government agency involvement and leadership include:
       Pivotal ability in assuring access to services, support and active participation of
        key providers across systems.
       Assistance with assuring the credibility of a program.
       Providing needed resources to assure that desirable action occurs, both at the
        individual and systems levels.
       Knowledge and expertise in governmental structures, policy and regulation.
Some of the challenges of government agency involvement and leadership include
       Bureaucratic delays and barriers.
       Inflexible policies.
Some of the identified benefits of non-government agency involvement and leadership
include:
       Non-profit organisations: skills in developing trust with clients, in meeting client
        needs, in responding flexibly to client need.
       For-profit organisations: skills in             innovation,      adaptability,     managerial
        effectiveness and entrepreneurship.
Because of this blend of positive and negative aspects of government or non-
government leadership in collaborative interagency case management, Pryor (2002)
recommends also a blend of leadership, “whereby a non-profit agency operates as the
official lead agency, but under contract with an oversight governmental agency” (p.47).


Key questions – as yet unanswered – for the literature on collaborative processes are:
        What level or breadth of collaboration is needed to achieve particular outcomes?
        What is the point at which efforts to increase collaboration are simply a waste or resources,
        without increasing desired outcomes? (Gajda, 2004, p.67).




Tiered support
“Tiered support” – described commonly in the Wraparound/ISP literature – recognises
that formal support for a young person exists at three different levels:
        o   one level being the team who work directly with the young person and their
            family;
        o   the second level being organisational with this team’s goal as addressing
            cross-systems problems;



Literature review update on integrated governance and approaches                                        7
MorganDisney & Associates
August 2005
        o   and the third level team addressing policy and regulatory systems.

Tiered support is also identified in the June 2004 review as present within the Tasmanian
Government Department of Health and Human Services – where the tiers consist of (1) the
existing service system, (2) the Key Coordinators located in each region, and (3) the Board for
Exceptional Needs.
        “Tier three comprise the Directors of all the Divisions of the DH&HS and this tier has
        two core functions: (1) governance of the Agency Collaboration Strategy – providing a
        forum for problem resolution and decision making regarding individual clients with
        exceptional needs, and; (2) providing a forum for collaborative policy making on
        standards, practice issues and generally ensuring integration is achieved.” (p.46).


As a part of the academic support for Wraparound teams, Korloff and her colleagues
(Koroloff, Schutte & Walker, 2003a; Koroloff, Walker & Schutte, 2003b) have identified
what “necessary conditions” are required – at the organisational and systems level –
for effective support to be provided by the team working directly with the young person
and their family. These necessary conditions (outlined on the next page) have been
developed through a method of “backward mapping” – where questions are asked to
identify the kind of support that a hands on team requires from organisations and that
organisations require from systems.
                                              “Practical experience has shown that achieving
                                              meaningful change at the service delivery level
   “Counties ideally need to find ways to     requires extensive support from the organizational
   pay parents as parent partners or          level, as well as from the system level (or policy and
   parent advocates, so they can afford to    funding context). This required support for the team
   be more consistently involved in the       ISP process can be hard to come by given that
   Tier I and II processes, and so they       organisations and systems are often locked in their
   can have more of a professional/peer       traditional ways of doing business by organisational
   stature with other professionals at the    cultures; inter-agency barriers; funding exigencies;
   table” (Korloff et al., 2003a, p.11).      and scepticism regarding the effectiveness of family-
                                              centred, strengths-based practice (Walker, Koroloff
                                              & Schutte, 2003, pp.3-4).




Literature review update on integrated governance and approaches                              8
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August 2005
Necessary Conditions for Tiered Support (Koroloff, Schutte & Walker, 2003; Koroloff, Walker, Rea, Schutte, 2003)
Team Level                       Organisational Level                                                               Systems Level (policy & funding context)
Practice Model                   Practice model                                                                     Practice model
i. Team adheres to a practice    i. Lead agency provides training, supervision, and support for a clearly defined   i. Leaders in the policy and funding context
model that promotes team         practice model.                                                                    actively support the ISP practice model.
cohesiveness and effective       ii. Lead agency demonstrates its commitments to the values of ISP.
planning in a manner consistent iii. Partner agencies support the core values underlying the team ISP process.
with the value base of ISP.
Collaboration / partnerships     Collaboration / partnerships                                                       Collaboration / partnerships
i. Appropriate people, prepared  i. Lead and partner agencies collaborate around the plan and the team.             i. Policy and funding context encourages
to make decisions and             E.g. A family’s ISP team plan serves as a baseline – other plans which may interagency cooperation around the team and
commitments, attend meetings        be maintained at partner agencies are the same as – or at least consistent the plan.
and participate collaboratively.    with – the goals and strategies expressed in the ISP plan.                        E.g. The policy and funding context
                                  E.g. Lead and partner agencies work to develop a common format for plans              encourages agencies to collaborate to
                                    so that the team plan can serve as the case plan for each agency.                    deliver ISP more effectively (for example,
                                  E.g. Lead and partner agencies work to reduce inefficient or redundant                by encouraging mechanisms for sharing
                                    requirements for paperwork and rules (e.g. developing common consent                 information about services and assistance
                                    forms, reducing redundant documentation of needs, etc.)                              offered at different agencies, by
                                  E.g. Lead and partner agencies work together to develop mechanisms for                encouraging co-training or co-funding of
                                    sharing non-confidential information (e.g. information on all services received      staff positions, or by encouraging
                                    by a family, up-to-date information about types of assistance offered by             mechanisms to share client information in
                                    various agencies).                                                                   ways that do not violate confidentiality.
                                 ii. Lead agency supports team efforts to get necessary members to attend             E.g. Leaders from the policy and funding
                                 meetings and participate collaboratively.                                               context work to ensure that ISP teams
                                   E.g. Supervisors and managers in the lead agency encourage all their                 aren’t required to do redundant work to
                                       own staff who need to be on ISP teams to attend meetings and be active            satisfy the requirements of various partner
                                       on the team.                                                                      agencies. (For example, by consolidating
                                   E.g. Supervisors and managers in the lead agency support all their own               requirements for documenting plans, or by
                                       staff who are members of ISP teams by flexing their work time so that they        supporting streamlining of consent
                                       can attend ISP meetings or complete other team tasks during off-hours.            processes).
                                   E.g. The lead agency gives its staff authority to make decision during team ii. Leaders in the policy and funding context
                                       meetings about access to services and funding at the lead agency.            play a problem solving role across service
                                   E.g. Managers in the lead agency support team efforts to get necessary boundaries.
                                       people from partner agencies to join teams and attend regularly.               E.g. There is a person or group with
                                   E.g. When team members from partner agencies who are needed don’t                    sufficient decision making authority who
                                       attend meetings, managers from the lead agency will work with the partner         acts to resolve problems that are


Literature review update on integrated governance and approaches                                                                                                   9
MorganDisney & Associates
August 2005
                                          agency to find a solution.                                                    encountered by ISP teams or programs
                                      E.g. When a team member from a partner agency is not being reasonably            and that arise from insufficient inter-
                                          open-minded or flexible with mandates, managers from the lead agency          agency collaboration. (For example:
                                          will work with the partner agency to find a solution.                         problems about who will pay for what,
                                    iii. Partner agencies support their workers as team members and empower             problems about access and different
                                    them to make decisions.                                                             eligibility criteria, problems stemming from
                                      E.g. Partner agencies demonstrate willingness to be flexible about their         conflicting rules).
                                          regular procedures to support the needs of the ISP process.               E.g. Individuals involved in ISP teams
                                      E.g. Partner agencies demonstrate willingness to be reasonably open-             and/or programs feel comfortable bringing
                                          minded and flexible around how to satisfy mandates.                           their complaints and concerns to this
                                      E.g. Team members from partner agencies get support from their                   problem-solving individual or group.
                                          agencies for attending meetings and being an active part of the team.     E.g. When this individual or group has
                                      E.g. Partner agencies recognize that being a member of an ISP team               made a decision, follow-through is
                                          requires a time commitment beyond attendance at ISP meetings.                 monitored to ensure that the decision is
                                                                                                                        implemented.
Capacity building / staffing        Capacity building/staffing                                                    Capacity building/staffing
i. Team members capably             i. Lead and partner agencies provide working conditions that enable high-     i. Policy and funding context supports
perform their roles on the team.    quality work and reduce burnout.                                              development of the special skills needed for
                                                                                                                  key roles on ISP teams.
Acquiring services/supports         Acquiring services/supports                                                   Acquiring services/supports
i. Team is aware of a wide array    i. Lead agency has clear policies and makes timely decisions about funding    i. Policy and funding context grants autonomy
of services and supports and        required to meet families’ unique needs.                                      & incentives to develop effective services and
their effectiveness.                ii. Lead agency encourages teams to develop plans based on child/family       supports consistent with ISP practice model.
ii. Team identifies and develops    needs and strengths, rather than service fads or financial pressures.         ii. Policy and funding context supports fiscal
family-specific natural supports.   iii. Lead agency demonstrates its commitment to developing culturally         policies that allow the flexibility needed by ISP
iii. Team designs and tailors       competent community and natural services and supports.                        teams.
services based on families’         iv. Lead agency supports teams in effectively including natural supports.     iii. Policy and funding context actively supports
expressed needs.                    v. Lead agency demonstrates its commitment to developing an array of          family and youth involvement in decision
                                    effective providers.                                                          making.
Accountability                      Accountability                                                                Accountability
i. Team maintains                   i. Lead agency monitors adherence to the practice model, implementation of    i. Documentation requirements meet the needs
documentation for continuous        plans, and cost and effectiveness.                                            of policy makers, funders, and other
improvement and mutual                                                                                            stakeholders.
accountability.




Literature review update on integrated governance and approaches                                                                                                  10
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August 2005
Other “essential” ingredients for integrated case management
Many of the themes raised in the Literature Review of June 2004 are reinforced by the
most recent literature. For example, characteristics such as (Berson et al., 2003;
Potter & Mulkern, 2004; Pryor, 2002; Meridian Consulting Services, 1999; Osher &
Hunt, 2002; Padgett, Bekemeier, & Berkowitz, 2004; Rea 2003; Rosenkrantz, 2004):
   the importance of having shared vision and goals amongst partners,
   agreed-upon decision making procedures,
   underpinning material resources,
   relationships with government which allow space for independence, autonomy and
    flexibility while also close enough proximity to allow for high level and positive
    policy and financial connections and support,
   client or family centred, strengths-based, flexible and individualised approaches,
   which involve families and young people at
    all levels of decision making – supported         While the focus of much literature in
    by training for both young people and their       the is on the involvement of young
    families, as well as the team that surround       people at all levels of the decision
    them.                                             making process, the Wraparound
   teams which are committed, and have high          literature focuses on the inclusion of
    levels of planning, monitoring and review,        parents as well (Korloff et al., 2003a).
    problem solving capacity, leadership and
    purpose.
Two new themes are also evident in the literature:
   The correlation between creative team processes and individualised plan
    development.
        For example, Walker (2004; and others such as Potter & Mulkern, 2004)
        suggests activities to enhance creative, individualised and flexible solutions.
        Such “creativity enhancement” activities include: brainstorming to broaden
        perspectives; generating several distinct options before making a decision;
        eliciting opinions or perspectives from each team member; mentioning specific
        strengths or assets of the young person and their family; and investigating,
        coordinating, tailoring or facilitating formal or regular community services or
        natural support activity (Walker, 2004).
   The wisdom of experience – with authors now able to reflect on ten years of
    involvement with Wraparound programs.
        For example, Meyers & Miles (2003) make recommendations about
        establishing sustainable inter-agency case management for young people at
        risk. While reinforcing many of the “essential” ingredients already mentioned
        these recommendations also emphasise: hand picking team members who are
        enthusiastic, have energy for families, are flexible, open to training and tolerant
        to change; working with high level allies, in a “frontier space” – where the team
        are close to the “system” and its supports, while also with enough distance from
        “the system” to be flexible and innovative; and developing capacity for ongoing
        leadership, particularly from parents who have been involved in the process
        before.
Conclusion
A strong body of research and literature now exists on integrated approaches and
service delivery implications. This brief update confirms the importance of staying
abreast of the research and evidence base and of examining the implications for
Literature review update on integrated governance and approaches                            11
MorganDisney & Associates
August 2005
governance and service development. Over the next few months the Consultancy
team is reinterviewing each of the initiatives contacted during the preparation of the
June 2004 Literature Review to establish:
       How each of these initiatives have progressed and what they have learned
       What they have achieved for young people
       What evaluation and/or research has been conducted
       How they have engaged the various service systems especially including the
        justice and accommodation support service systems.


That work will be reported in November 2005.




Literature review update on integrated governance and approaches                   12
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References

Berson, I.R., Vargo, A.G., & Roggenbaum, S. (2003). Child welfare targeted case
management current practices and implications for statewide dissemination and
implementation. Tampa, FL: Loius de la Parte Florida Mental Health Institute,
University of South Florida (available online: www.fmhi.usf.edu/institute/pubs/bysubject.html)

Burnett, R. & Appleton, C. (2004). Joined-up services to tackle youth crime. The British
Journal of Criminology, 44(1), 34-54.

Das, T.K. (2002). The dynamics of alliance conditions in the alliance development
process. Journal of Management Studies, 39(5), 725-746.

Gajda, R. (2004). Utilizing Collaboration Theory to Evaluate Strategic Alliances.
American Journal of Evaluation, 25(1), 65-77.

Hattori, R.A. & Lapidus, T. (2004). Collaboration, trust and innovative change. Journal
of Change Management, 4(2), 97-104.

Koroloff, N., Schutte, K., & Walker, J.S. (2003a). The context of services for effective
ISP/Wraparound: Assessing the necessary agency and system support. Focal Point,
17(2), 8-11. Accessed online, May 2005, at www.rtc.pdx.edu.

Koroloff, N., Walker, J., Rea, T., Schutte, K. (2003b). Assessing ISP/Wraparound
Implementation at the Team, Organization, and Systems Levels, presentation to the
10th Annual Building on Family Strengths Conference, Portland, Oregon, NSW.
Accessed online, May 2005, at www.rtc.pdx.edu.

Lee, E., Dillon, A., Dorries, V., Beech, M., & McDermott, B. (2004). Responding to
serious and complex mental health problems in youth: the role of an interagency forum.
Australian Psychiatry, 12(3), 264-267.

Lepler, S. & Rosenkrantz, R. (2003). A blueprint for change: Restructuring Erie County
government to improve the impact and effectiveness of services to children and
families. Centre for Governmental Research: New York. Accessed online, May 2005,
at www.cgr.org.

Meridian Consulting Services Inc. (1999). Integrated Systems of Care for Children’s
Mental Health: A Technical Assistance Resource Book. Conference of Local Mental
Health Hygiene Directors Inc. New York State.

Meridian Consulting Services. (2002). Streamlining and strengthening services for
children, youth and families: A plan of action for Tioga County. Centre for
Governmental Research: New York. Accessed online, May 2005 at www.cgr.org.

Meyers, M.J. & Miles, P. (2003). Staying the course with wraparound practice: Tips for
managers and implementers. Focal Point, 17(2), 17-20.

Osher, T. & Hunt, P. (2002). Research and Program Brief: Involving the families of
youth who are in contact with the Juvenile Justice System. National Center [sic] for
Mental Health and Juvenile Justice: New York. Accessed online, May 2005, at
http://www.ncmhjj.com.

Padgett, S.M., Bekemeier, B., & Berkowitz, B. (2004). Collaborative partnerships at the
state level: Promoting systems changes in public health infrastructure. Journal of
Public Health Management and Practice, 10(3), 251-257.

Literature review update on integrated governance and approaches                           13
MorganDisney & Associates
August 2005
Potter, D. & Mulkern, V. (2004). Wraparound Services., Issue Brief prepared for the
Community Living Exchange at Rutgers Center [sic] for State Health Policy, National
Academy for State Health Policy, USA. Accessed online, May 2005, at
http://www.cshp.rutgers.edu/CMSNewFreedomInitiative.htm.

Pryor, D (2002). Coordinated children’s services initiative (CCSI) in New York State:
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Appendix: Turnaround Literature Review (June 2004) SUMMARY
Method
The review examined the literature relating to support and service provision for young
people at risk, and, in response to the minimal literature available, and reported on a
series of interviews conducted with current service providers across Australia. The
themes discussed were: participation of young people in decision making; case
management; working with families; and governance and collaboration.
Participation of young people in decision making
 Critical when working with empowering, rights-based and strengths-based models;
   may require training support for the young person and the team that surround them.
   Participation must be wide-reaching: in decision making about the young person’s
    own life as well as in all aspects of service planning
Working with families
 The evolving theoretical underpinnings of working with families is traced,
  strengthening the theoretical importance of working with families.
   Interview data with service providers confirmed that working with families and
    mediation skills are integral aspects of working with young people at risk.
   Support for families is ideally simultaneous, but separately provided to the support
    for the young person. Support provided to the young person should not be the sole
    source of support for the family.
Case management
 Six common elements of integrated case management practice: client centred –
   individualised, developmentally appropriate, strengths-based; multi-system –
   involving support from a range of sources and stakeholders; team commitment –
   commitment to shared goals and support strategies; planning – essential for
   coordinated, appropriate and comprehensive support; and monitoring and review –
   for effective and reflective support provision.
   The practice implications of the findings included: the need for a common language
    and understanding of “case management” terms; the importance of planning and
    systemic relationship building to facilitate shared organisational commitment; a
    requirement for ongoing evaluation and documentation of case management
    practice; risk management to support the safety of clients and workers; case load
    management – identifying appropriate levels, numbers and complexity; adequate
    staff supervision and support; recruitment, training, remuneration and retention; the
    value of outreach based service delivery; issues of “ownership” in situations with
    numerous stakeholders; and supporting the pivotal role of police.
Governance and collaboration
 The characteristics of the successful collaborative governance of integrated
   initiatives are described as including: a shared vision and planning; effective
   communication and conflict resolution; problem solving capacity; adequate and
   shared resource allocation; leadership and purposefulness; involvement of all
   stakeholders; a strong focus on outcomes for clients; and with collaboration
   recognised as imperative, as a journey not a destination, and involving the personal
   as much as the procedural.
   The implications for Turnaround practice included an acknowledgment of the
    benefits of; the high level membership of the management committee; the early
    planning and establishment of an outcomes-focused evaluation framework;

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    commitment to adequate resourcing; skilled and experienced staff with clear roles;
    and a focus on collaboration.




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