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Community Affairs References Committee
17/04/2015
Out-of-home care

FEATHERSTONE, Mr Gerald, Chief Executive Officer, Kummara Association Inc.

HARMON, Ms Karen, General Manager, Australian Programs, Abt JTA

LEWIS, Ms Natalie Louise, Chief Executive Officer, Queensland Aboriginal and Torres Strait Islander Child Protection Peak

DONNELLY, Ms Julianne, Team Leader, Australian Nurse-Family Partnership Program

[14:17]

CHAIR: Welcome. Could I double check that you were given information about parliamentary privilege and protection of witnesses and evidence. I would like to ask whoever wants to to make an opening statement and then we will ask you some questions.

Ms Lewis : I am happy to start off. QATSICPP is the state peak body for Aboriginal and Torres Strait Islander community controlled child protection services across Queensland. Our membership base comprises 21 community controlled organisations that deliver the services of the recognised entity, family support services, intensive family support services and also foster and kinship care services.

In terms of looking at child protection in a national context, I am trying to focus the conversation there. I am sure you are aware of the activity relating to the recommendations of the Carmody inquiry, and I am sure that witnesses later in the day will speak more specifically about that. It is in considering the factors that contribute to the over-representation of Aboriginal and Torres Strait Islander children in the out-of-home care system that the shared nature of the responsibility between the federal government and the state government is most evident.

Given that the risk factors that contribute to over-representation stem from a number of areas but primarily intergenerational trauma as a legacy of colonisation and government policy throughout history and the ongoing impact and disruption of family and cultural life, this exacerbates the experience of pain-based behaviours such as domestic and family violence, alcohol and drug misuse and mental health issues. There is certainly a higher prevalence of poverty, homelessness and limitations in accessing appropriate, affordable and sustainable housing and significantly higher levels of unemployment and interaction with statutory systems such as youth justice, the criminal justice system and the child protection system. There is also well-documented evidence about compromised outcomes in relation to health and educational attainment. When unpacking the concept of neglect in Aboriginal families, it is apparent that the key drivers include poverty, poor housing and lack of equitable access to appropriate services. Both poverty and poor housing are arguably outside of the domain of parental influence, so it is unlikely that a family, while being in the child protection system, could effectively redress these risks in the absence of other social investments and strategies to alleviate poverty and improve access to appropriate housing.

It is also accepted that domestic and family violence, drug and alcohol abuse and mental health issues are recognised risk factors. A Queensland department of communities report that examined the characteristics of parents involved in the child protection system identified a high prevalence of all of these factors and an increased likelihood of the presence of multiple parental risk factors amongst Indigenous families. Each of these factors exists within the personal domain for change. As long as equitable access and appropriate pathways to appropriate services exist for families, these factors could theoretically be sufficiently resolved to ensure that unacceptable risk is not posed to any child. There is compelling evidence, including that which is presented in our most recent inquiry, which indicates a direct relationship between the lack of accessible universal primary and secondary options that could mitigate risk of family crisis, and the high proportion of Aboriginal and Torres Strait Islander families who experience family crisis and child maltreatment. It is suggested that providing a diversity of primary and secondary services, augmented by a deliberate service coordination approach, would reduce the scale of crisis-related interventions. Unless the orientation becomes one of prevention and early intervention, then the longer-term outcome is a substantially more costly enterprise for the community to fund.

A balanced package of interventions would facilitate non-stigmatised access along a continuum of support that is determined by need and complexity rather than the source of the referral or the body that funds the program. It is clearly understood that family circumstances are constantly changing, and as such the service models need to be flexible and able to respond in a dynamic way, allowing mobility between service types and intensity along the continuum. It is a very clear focus in Queensland in the reform agenda to remove the silo approach to services so that families can access the range and scope of services that they require to address their needs when they occur, as opposed to allowing those to build up to a point of crisis where departmental intervention is required.

Mr Featherstone : My opening statement is more about us and where our location is within this particular sector. Kummara Association is a family support-early intervention agency. We have been running a long day childcare centre for the last 19 years, and family intervention services—that is, reunification programs with families—are our dealings with foster care and out-of-home care. We have early intervention through the Aboriginal and Torres Strait Islander family support service Queensland government funding initiative, which was a separation of the ARI-recognised entity roles into more early intervention. And we have the Indigenous parenting service, which is a federally-funded program under the Indigenous access strategy. It is currently under new funding, and is about school engagement, retention and getting our children to school. For us as an agency it is more about our work—we deal with foster care, child safety and out-of-home care placements, specifically with our intensive family support program-family intervention services. I will be happy to answer questions as we go along.

CHAIR: Thank you. Ms Harmon, you were out of the room, so I did not get to ask you if you have been given information on parliamentary privilege, on the protection of witness evidence.

Ms Harmon : Yes.

CHAIR: I understand you will be making the opening statement—though you, Ms Donnelly, are more than happy to—

Ms Harmon : She is available to answer questions later. Firstly, I would like to acknowledge the traditional owners on the land on which we meet today and also on the lands where we conduct our programs, and I pay our respects to elders past and present.

Abt JTA runs a program as a support to the Australian Nurse-Family Partnership Program. As I go through this statement, you will come to understand what that program actually does. It is known that caregiving experiences, both within and outside children's homes, impact on child development and wellbeing. An important extension of this understanding focuses on changes in caregiving context due to child maltreatment and the subsequent out-of-home placement of children. The Australian Nurse-Family Partnership Program is an evidence-based, nurse-led home-visiting program which works with Aboriginal community controlled health services and supports women who are pregnant with an Aboriginal or Torres Strait Islander child. The purpose is to improve their own health and the health of their baby. The ANFPP, the Australian Nurse-Family Partnership Program, also provides valuable support and advice to mothers which helps with the baby's development in their early years. The ANFPP is an important early investment in the future of Aboriginal and Torres Strait Islander children.

The Nurse-Family Partnership model which the ANFPP is based on is founded on the pioneering work of Professor David Olds, professor of pediatrics, psychiatry and preventive medicine at the University of Colorado in Denver. This program was first introduced in the United States of America, targeting first-time mothers from low-income and disadvantaged backgrounds. Following three randomised controlled trials over a period of three decades, the evidence gathered to support the impact and effectiveness of the program continues to grow. This program has now been rolled out globally: across 48 of the states of the US; England, Scotland, Wales and Northern Ireland in the UK; two provinces in Canada; across the Netherlands; and in Australia. It is about to be implemented in Norway and Bulgaria.

The Australian model has been adapted to meet the unique needs of its current target group, which is first-time mothers of an Aboriginal or Torres Strait Islander baby. In Australia, Abt JTA manages the program support service for the Australian government's Department of Health, through the Indigenous and Rural Health Division. The Nurse-Family Partnership Program provides home visits by registered nurses and midwives to first-time mothers, beginning during their pregnancy and continuing through to the child's second birthday. The program has three primary goals: to improve pregnancy outcomes by promoting health related behaviours; to improve child health development and safety by promoting competent caregiving; and to enhance parent life course development by promoting pregnancy planning, educational achievement and employment. The program has two secondary goals, which are to enhance families' material support by providing links with needed health and social services, and to promote supportive relationships among family and friends.

The program was originally developed to address the underlying causes of antisocial behaviour. Antisocial behaviour is defined as behaviour that violates social rules or harms others. When this behaviour begins at an earlier age, it is likely to be more severe and is more likely to persist than antisocial behaviour that generally begins in adolescence. The three main factors that have been found to be associated with the early onset of antisocial behaviour include: the neurodevelopmental impairment of the foetus, and children of women who engage in risky behaviours such as the use of cigarettes, alcohol and other drugs are more at risk for this kind of impairment; dysfunctional caregiving, which generally refers to inadequate parental provision of material and emotional care; and maternal life course development. Children of women who are on welfare or unmarried or high-school dropouts or have three or more children are more likely to have children with reported behavioural problems. The three primary goals of the program directly address the three main risk areas that I have just mentioned. The content of the program is grounded in three theories—human ecology, human attachment and the theory of self-efficacy—but I will not go into those unless anyone is particularly interested.

The Australian Nurse-Family Partnership Program is an adaptation of the NFP, the Nurse-Family Partnership, which I described earlier, and it has been adapted to the Australian Aboriginal and Torres Strait Islander context. While it still adheres to the fidelity of the original program, the program now includes Aboriginal and Torres Strait Islander family partnership workers, who provide a cultural bridge early in the relationship as it is being developed between the nurse home visitor and the mother and her family.

The Australian program also has a strong focus on social and emotional wellbeing. The program is funded through the Closing the Gap initiative of the Commonwealth and there is a licence from the University of Colorado to implement the program that is held by the Commonwealth of Australia as well through the Department of Health.

The Australian Nurse Family Partnership Program has been implemented in four Australian states thus far, as I said before, within the community controlled health service. At the moment, we implement the program in: Wuchopperen in Cairns in Far North Queensland; at Congress in Alice Springs in the Northern Territory; and in Wellington, which is in New South Wales. It was formally implemented in the Victorian Aboriginal Health Service in Fitzroy but that program ceased. I can answer further questions surrounding that issue if you like.

The ANFPP aims to improve the health, wellbeing and self-sufficiency of young mothers and their children. So the objectives of the ANFPP are to improve the outcomes in pregnancy by: improving women's pre-prenatal health; improving each child's health and development by helping mothers to provide more skilled parenting; and assisting the parental life course by helping mothers to plan future pregnancies, complete their education and to find work if that is what their desire and aspiration is.

The ANFPP is one of a number of maternal and child health services that the client will access during pregnancy and in the first two years of life—so it is additional to, not in place of the referral and encouragement of those others services that exist. The ANFPP is a primary healthcare program that works in collaboration with maternal and child health services as part of the nurse home visitor program. The nurse home visitor is a partner, trainer and supporter who helps to improve the mother's health and the health of the baby.

This program had its inception in Australia in 2009 into an original three sites. We have recently been informed that the Commonwealth, through the Closing the Gap initiative, is going to extend those sites by a further 10 to a total of 13 sites. The additional 10 sites are yet to be confirmed, but, in the main, they will be focused on Aboriginal community controlled health services.

Since its inception in Australia in 2009, our role has been to collect data as well as provide training for the nurses, midwives and family partnership partners who are involved in this program. It is important that the data is collected because we are intending to add to the really strong evidence base of the program. What we were able to acknowledge in our latest report was that there has been: a significant reduction in smoking, which is demonstrated by the clients from intake to 36 weeks of pregnancy; that smoking has been steadily reducing at 36 weeks of pregnancy over the last three years from 40 per cent in 2012 down to 23 per cent in 2014; that 64 per cent of clients reduced smoking whilst engaged with the program; and 34 per cent of clients were identified as smoking at any time during pregnancy. The percentage of full-time infants of low birthweight was reduced from 11 per cent in the year before and three per cent this year—less than the national average for non-Indigenous mothers in fact.

There has been a progressive decline since 2012 in preterm births—that is, births at less than 37 weeks of gestation for clients in our programs. Nationally, 95 per cent of babies born to clients of the program were initially breastfed, which exceeds the rate of 75 per cent identified in 2008, according to a national survey of Aboriginal and Torres Strait Islander women as found in the Australian Institute of Health and Welfare statistics. At one site, 68 per cent of infants of clients of the program were still being breastfed at six months of age. Approximately 92 per cent of infants within the program are stated as fully immunised at 12 and at 24 months of age. There has been a consistent decline over the last three years in subsequent pregnancies within two-years of the referral pregnancy for clients in the program.

The average scores for all age groups of children in the program for the ages and stages questionnaires, which are the standard questionnaires used in maternal and child health services that cover communication, gross and fine motor skills, personal, social and problem solving, were equivalent to the standardised norms across Australia. The average English language assessment scores for boys within the program were equivalent to the 50th percentile, which was really quite incredible because generally you find that it is the girls that have the higher levels of English communication and language scores. The average English language assessment scores for girls within the program were significantly less at 47 per cent. Infants within the program at 10 and 14 months scored higher than the norm for communication and at 14 months scored higher for the personal social section. These outcomes are consistent with the findings of the three randomised controlled trials that were conducted in the United States over three decades.

Importantly, and reflecting on some of the evidence that has come before us, recent findings from a randomised controlled trial that was conducted in the Netherlands on the program have identified, through a study on the effect of nurse home visits versus usual care on reducing intimate partner violence in young, high-risk pregnant women, that the Nurse-Family Partnership Program is effective in reducing IPV, or intimate partner violence, during pregnancy and in the two years after the birth of the child. A 15-year follow-up of the first randomised controlled trial of NFP in Memphis in the United States demonstrated that prenatal and early childhood home visits by nurses reduced serious antisocial behaviour, including running away from home, fewer arrests and convictions, reduced smoking and alcohol consumption, fewer sex partners and emergent use of substances by adolescents born into these high-risk families.

CHAIR: Ms Donnelly, did you have anything to add?

Ms Donnelly : I am happy to answer questions, but I have not got anything to add.

CHAIR: Ms Harmon, the program started in three or four sites in 2009?

Ms Harmon : In 2009 it began in Victoria, the Northern Territory and Far North Queensland; those three sites.

CHAIR: Are the stats you just gave us an average across all those three sites?

Ms Harmon : From the three sites, exclusive of Victoria—they only stayed in the program for two years.

CHAIR: Why was that?

Ms Harmon : There were internal issues with the community controlled health service and there was a decision by their board to use their funds in a different manner.

CHAIR: So the funding you have got to run the program now comes directly from the federal Department of Health?

Ms Harmon : Yes.

CHAIR: And you have now been given it for another—

Ms Harmon : We are in the process of negotiating the next five years.

CHAIR: Is that straight through the department or is it through IAS?

Ms Harmon : Through the Indigenous and rural health unit in the Department of Health. They fund the support service that we conduct and they fund the community controlled health services to employ the staff for the program.

CHAIR: So you provide the support services?

Ms Harmon : Yes.

CHAIR: What are they?

Ms Harmon : This program is absolutely dependent on the fidelity of the program, so there is quite specific training curricula that is provided. We undertake that and we do monitoring and evaluation. We collect the data and analyse it and report to the Commonwealth on the outcomes of the program.

CHAIR: So you work directly then with the nurses or with the AMSs, or both?

Ms Harmon : All of those.

CHAIR: Mr Featherstone, I want to go to the work you have been doing. I am trying to look at what you find is the best way for you to support your foster carer families. What do you find are the key things that are essential for supporting foster carers?

Mr Featherstone : We are engaged to work with the families. We are not actually supported to work with foster carers.

CHAIR: Okay; I have misunderstood what you said in that case.

Mr Featherstone : That is all right. One of our programs is family intervention or reunification, so we work at reunifying children when they have been removed and actually working with foster carers. We are probably more aware of some of the issues that are present within that. One of those is this: we are working with families—doing parent training, parent support, parent education—but the foster carers are not privy to what we are doing, so they are undoing what is happening between parents and their children and almost reporting against our parents because they do not believe the parents are doing what they need to be doing. They do not believe it is proper, so all of a sudden we have another factor that is negatively influencing the opportunity for us to reunify quicker.

CHAIR: Can you take me through that?

Mr Featherstone : Yes. We do circle of security parenting, which is an attachment based program. It is evidence based. We run our parents through that. The foster carers are not aware of specific terminology, so 'top of the circle', 'bottom of the circle', 'hands', 'being with', 'providing comfort', 'filling my cup' are examples. They will see the parents waiting patiently, being available, and then they will tell the child safety officers, 'We don't think the parents are doing their job', because of what they are seeing. They are making judgements that are not informed on current evidence. It is about an opening, that foster carers need to access training that is similar to what the parents need to go through so that they can be on the same page. We do not have parents and foster carers coming together. If anything, we have them being quite antagonistic.

CHAIR: And are we talking about foster care—so when you say you engage with foster carers, now I understand what you are saying about engaging with foster carers. Are you talking about Aboriginal and Torres Strait Islander foster carers, or all of them across the board?

Mr Featherstone : All of them. Primarily our children—the biggest difficulties we have are when we do not have kinship care placements. We do not have a lot of those; they are very hard to get, without a doubt. Relative care, which is supported—relative care is available, but there are large hoops that the families have to jump through for them to be acknowledged that they might be the best suited family. So there are things like blue cards and convincing departmental staff that this would be a good option. It is quite difficult because sometimes it is easier to say: 'Listen, we've got foster carers. They're trusted. We'll put the families there and then we can not stress about the child at this particular time.' It is that interface that we struggled with. It is how we convince them knowing full well that we can provide support for the parents, the relatives carers and the children as well.

One of the difficulties when children are removed is that there is no sense of follow-up. I was talking to Natalie yesterday about this. One of the difficulties I have is if I have a family where the children have been removed and they are not upset. That raises alarm bells for me; that means they are not impacted by this. The ones that are upset, that means I can do something with these families. They are feeling it intensely, they are feeling it deeply, but no-one is taking responsibility to help those families manage those intense emotions. That is one step. The other one is: who is helping the children manage those intense emotions when they are removed? They are actually separated from their family. Unless they are sticking their hand up, which is different, saying, 'I want to get out of here', and some do that, then it is putting the effort into making sure we are meeting the needs of the family and the children and also helping foster carers realise that this is going to be a little bit about managing trauma for the child and asking: 'Do you feel suited? Do you feel supported? Are you able to do this? What do you need from us or from other services to actually help with that?'

CHAIR: You are not funded to help the foster families do that?

Mr Featherstone : No.

CHAIR: You are working with the parents and the kids?

Mr Featherstone : When we need to, yes. It is about connecting the children to specialist support. If we cannot locate that, then we will fill that gap.

CHAIR: If the kids are not able to access other trauma informed therapy, for example, you will then—

Mr Featherstone : Yes. Our staffing is social workers, nurses, psychologists. They are the levels we have within our organisation.

CHAIR: Okay. So you specifically focus on the parents, to build parental capacity—

Mr Featherstone : Yes.

CHAIR: for a reunification. You said that, when foster families and foster carers do not get that, it causes trouble. Can you expand on that a little bit for me?

Mr Featherstone : Yes. From some of the things that I have become aware of, the foster carer relationship is with their departmental worker. There is no relationship encouraged or supported between the foster carer and the parent, which, if we are looking at best opportunities, might be something to look at: how do we have a therapeutic fostering arrangement so that we can have continuity of learning support? So there is the communication pathway between foster carers and the department; and there is our communication pathway between us, the parents and the department; but there is a missing bit.

We might be trying to convince the department that the family are moving well, but then the foster care family are also giving input about what they think should be happening for the reunification of the family. Unless they are actually a recognised therapeutic foster-care provider, that is probably not something they should be doing. Then it is incumbent upon the child safety officer to make sense of that, which is really difficult because they have to listen to what the foster carer is saying and they cannot not act on something if it has a serious flavour to it. In one example, the foster carer did not think that the family provided lunch at a contact; that was not true. But because they did not see it, it was their observation, and then they actually used that. We had to undo that and say, 'No, that's not true. We were there. Lunch was provided. Activities were provided.' It becomes a part of the situation that misshapes it, that moves it away from where it needs to be.

CHAIR: How often would you say that is an issue?

Mr Featherstone : I am going to say it is a regular issue. Competition between foster carers and parents presents quite regularly. We have had foster carers accessing or arguing about accessing QCAT to stop reunification, and, because of the threat, reunification has been stalled and stopped because the department has to deal with that.

CHAIR: QCAT?

Mr Featherstone : Queensland Civil and Administrative Tribunal.

CHAIR: That is what I was assuming, but I could not quite work out the acronym. So the foster carers threaten to stop the reunification?

Mr Featherstone : Yes, because they do not believe the child should be returned to their parents, which tells me that there is work needed within the foster care component. They need to realise this is not a permanent deal: 'You are fulfilling a need, and we need to make sure you are supported—but this is your role within this.' If there is a problem, we actually involve people outside of that. There should be a group of informed decision-makers around that.

CHAIR: Okay. And we are specifically talking here about Aboriginal children going back to their parents?

Mr Featherstone : Yes.

CHAIR: Okay. Thank you. Is it just the threat of the foster carers going to QCAT that will stop the parents from seeking reunification?

Mr Featherstone : Parents struggle with QCAT. The process is there for them to use. We have been doing family intervention services since 2006. I think we have had one family successfully navigate that process.

CHAIR: So once they are in—

Mr Featherstone : Once they are in care, they are going to stay there for a little while, and that is probably a gentle way of saying 'a long time'.

CHAIR: In terms of the reunification process, how long does it take? I know it is hard to state an average.

Mr Featherstone : It is a good question. It is long. A lot of our work does not start—and I heard the previous witnesses—until families have been in departmental care for 12 months. Then we have 12 months until the order expires. All of a sudden, we need to do the work. We are involved, we received a referral, but the work around helping families manage their loss and the trauma has not taken place. That should have taken place on day one—on day one.

CHAIR: In that first 12 months.

Mr Featherstone : Yes, straightaway looking at how we manage the loss for the family—knowing full well that they are now within a legislated system and it is too late. That is about skilling up all of the workers, including departmental staff and NGOs: how do we manage intense emotions, the use of empathy, understanding that it is okay to be angry but, 'How do I help a family get to the next stage,' to move past that to, 'Now it's time to do some work to get ready.'

CHAIR: Mrs Lewis, you look like you want to add something.

Mrs Lewis : We had this discussion just yesterday. I think it is important. We miss an opportunity when families are at the point of removal where they are potentially most motivated. While they may present as angry or very upset, sometimes understandably, if we miss that as an opportunity to engage them and motivate them towards focusing on reunification and doing the hard yards with a service provider, because of the history and, as some of the witnesses earlier talked about, the longer that period goes on people become reticent and they assume this is just how it happens and they resign themselves to the fact that the kids are not coming back. So motivation decreases and you have to wait for the next crisis to capitalise on that opportunity again. That should not be the experience for families.

While I think there is certainly a very clear focus in Queensland to reorient the system towards prevention and early intervention and to get families the support they need earlier, we must not lose sight of the fact that we do have opportunities at various points of tertiary intervention where we absolutely should maintain a presence.

CHAIR: I want to understand you correctly. While there is now a focus moving on to early intervention, are you saying tertiary intervention late in the peace and that it is important that we are still working with families as soon as the kids are taken into care so that we are not missing an opportunity if it is possible for reunification—is that right?

Mrs Lewis : Yes. It is around sustaining that goal of reunification. If families are engaged and supported in the process and, yes, there may have had to be a removal, and they are empowered to be part of that decision-making process then the likelihood of reunification is increased. But it also maintains a focus on the opportunity for reunification. A lot of time we see almost a degree of placement maintenance. When a child is removed and placed in out-of-home care and if that child is not placed within their extended family or a kinship placement, revisiting those cases at six-monthly intervals becomes an exercise of examining whether the placement is stable and whether the child is safe. If those two things can be satisfied, to me that is placement maintenance. It is not actually utilising the opportunity to question whether we got the placement right in the first place. Have things changed now and is the family accessing supports that may make it a viable option to reunify them? Have we appropriately explored kinship options? Is there an alternative available?

It is important to continue to focus on the opportunity for reunification, particularly with Aboriginal and Torres Strait Islander children. A lot of the time at the point of removal, if an immediate family member or extended family member is not known or is not readily identifiable as a placement option then there is a high likelihood that that child will be placed with a non-Indigenous carer. Therefore, the risk of that child lagging in a safe but stable placement is compromising their connection to kin, country and culture. We need to maintain a focus on revisiting placement options for those children if an extended stay is required.

Mr Featherstone : IfI could add to the concept of time here. The example we have, and we do come across this quite frequently, is this: a child is removed, the family are on Centrelink benefits and if the child does not come back within a short period of time, their finances are significantly affected, they cannot afford their house anymore, they have to relocated and all of a sudden they are out of that area. This adds another layer of difficulty. The department then says, 'Until you have stable housing, we actually can't look at reunification.' Now we have another barrier that has been introduced. I am not saying this is something we can do in all cases, but if the focus could be on how to identify and remove the barriers to faster reunification in a safe manner to make sure the focus is on the safety of the child then we will not get to the barriers that present later on—housing and schools. All of a sudden I have my child in this school and I have to take him out because I have to leave the area. So now I have another child who is going to be impacted because they are going to miss school while I am looking to housing. So I am thinking of the interconnectedness between this one particular point and how to address it.

CHAIR: Can I ask how successful the unification processes have been.

Mr Featherstone : For us very successful. It does take a long time. The average for us is between eight to 18 months. We try to push for earlier but it is about convincing the decision makers of what we are doing. I have always advocated for shared decision making so that, if it is the department, they can actually leverage off the other professional knowledge as well, knowing full well that while supports are available we can stay there and ensure success.

CHAIR: Are they proving to be sustainable reunifications?

Mr Featherstone : Yes, they are. It is through the intensive work we do. So we will meet with families regularly during the week and identify the case plan goal. We also have an evidence based component called the Parents Under Pressure program, as well as our Circle of Security attachment program and we use a family partnerships model, which may be a part of Nurse-Family Partnerships—I am not sure. I know they do the training in the UK, around which a question may be asked I am seeing the shaking off its.

CHAIR: I am seeing the shaking of heads.

Mr Featherstone : Okay, that is no. In the UK they use that for the nurse-family partnerships, which is actually—

CHAIR: Use both programs, do you mean?

Mr Featherstone : Yes. It is a cultural engagement tool which is about engaging with the family.

CHAIR: Not just the mum.

Mr Featherstone : It is about engaging the professional with the client and it is a model they use which is more about separating from being the expert to, 'I bring expertise and it helps with engagement.' For our service we have 84 per cent engagement between families that are referred to us, plus also families knocking on our door. So four out of five are saying, 'Yep, we want to work with you guys.'

CHAIR: Right, so you then provide ongoing support to the families after reunification. Is that what that program does?

Mr Featherstone : We have a couple of programs which allow us to have a stepdown process. So the Family Intervention Program can work for three months through our service agreement. If and when the order has been rescinded and the family has been reunified, in that three months we are doing maintenance and also connecting with our other services. For example, our Indigenous family support service can work for a lot longer and we have our Indigenous parenting service, a federal program, which can be open-ended. And there can be a monthly follow-up, plus being available for families to reconnect, knocking on the door and saying, 'Listen, I want to talk to you guys. I've got housing, I've got school issues, I've just struggled with a broken car and I need to get my kids to school. How do we do this?' We help them problem solve.

CHAIR: You did say how you funded it. I'm just going back to my notes.

Mr Featherstone : Yes. Our child care is federally funded. It is a budget based program. The Indigenous parenting service is federal program through the Department of Social Services. Then we have our family intervention services and Indigenous Aboriginal and Torres Strait Islander family support services, which are from the Department of Communities, Child Safety and Disability.

CHAIR: Queensland?

Mr Featherstone : Yes. Queensland and Brisbane region is our space.

CHAIR: So you have a mixture of state and federal funding?

Mr Featherstone : Correct.

CHAIR: Thank you. Ms Harmon, I am interested to know how many of the mothers you have worked with of the families over that period.

Ms Harmon : Two hundred.

CHAIR: Are you aware of the outcomes for those. You have given us the overall outcomes in terms of reduced smoking and things like that. Have any of those children ended up in care?

Ms Harmon : No.

CHAIR: So of the 200 you have worked with—

Ms Harmon : The data we have only covers up to exit from the program. So the longitudinal study is still in progress because we have only been fully implemented—we undertook the initial implementation in 2009, so we have 2010, 2011, 2012, 2013. The earliest graduates of the program are still only four years of age.

CHAIR: We are still seeing kids that age being taken into care?

Ms Harmon : Yes. The data we have so far indicates that that is not the issue, that they are not taken into care. The home visits are intensive over the course of the program, if the mother is engaged for the entire time, which is usually two years and six months. We try to get them at the beginning of the second trimester of pregnancy. Sometimes its later. What we are finding is that, if they come in early, there is up to, I think, about 40 home visits over the period of time, so it is very intensive. It is aimed at developing that self-efficacy, the aspirations of the mother. The client is the mother; it is not the child. But because you are capacity building the mother, you are capacity building her ability to parent—and you extend that into the family environment as well.

CHAIR: You mentioned the longitudinal study before?

Ms Harmon : There has been a longitudinal study in the United States.

CHAIR: What about the Australian one?

Ms Harmon : We are still too early to engage in that longitudinal study. We are at the beginning point of that longitudinal study. There is an intention, absolutely, because the more evidence that we collect the stronger the evidence base that is providing that commensurate evidence that we are gaining from the experiences in the United States. In the United States, the first randomised control trial was conducted in Elmira in New York state. It was with Afro-American mothers who were vulnerable and who were considered to be in poverty and subject to both community and family violence and high-risk behaviours. That 15-year longitudinal study out of the United States is coming out with the support for reduced adverse impacts on children in adolescence and now into adulthood, because many of the graduates from those programs are now 30-plus years. Most importantly, I think for this discussion are the trials that have come out of the Netherlands, which had a real focus on intimate partner violence. I do have a study here with me, but I am not going to go delving into it right now. But my memory tells me, and I can confirm it, that out of that study the vulnerable communities that were targeted were immigrant communities, particularly North African immigrants into the Netherlands.

CHAIR: And they are starting to get the long-term outcomes?

Ms Harmon : Yes.

CHAIR: Could you take that on notice to double-check that and give us any further it information on that.

Ms Harmon : Yes, absolutely.

CHAIR: That would be very much appreciated.

Ms Harmon : I can leave you with the data, if you like?

CHAIR: That would be great. Thank you. Mr Featherstone, you look like you wanted to add something?

Mr Featherstone : No, I was listening intently.

CHAIR: Thank you. That is the end of my questions. Thank you very much for your time today it is very much appreciated and very helpful.

Proceedings suspended from 15 : 03 to 15 : 15