Quality Management Framework
Quality Evaluation
Wize Therapy Pty Ltd
Whole of Organisation
(Disability Services Commission funded services)
Booragoon
Final Report
11 September 2013
This report was prepared by an Independent Evaluator from the Panel Contract of Independent Evaluators. The Panel Contract is managed by the Disability Services Commission
Team leader: Deb Saville
Report prepared for: Quality Unit
Disability Services Commission,
146–160 Colin Street, WEST PERTH WA 6005 Phone: 9426 9727 Fax: 9481 5223
Order of contents
1. The evaluation visit 2. Acknowledgements 3. Service point profile 4. Executive summary
A. Good practices B. Required Actions
C. Key Priorities for Service Improvement D. Matters for further exploration
5. Meeting outcomes 6. Compliance check 7. Appendix
A. How the quality of your service is measured B. Disability Services Standards
C. Disclaimer
1. The evaluation visit
This report describes the findings of the Independent Evaluator who visited Wize Therapy Pty Ltd in August 2013 and completed an assessment of the service point’s progress towards meeting Outcomes under the Quality Management Framework (QMF) and compliance with the Disability Services Standards. The preliminary meeting was held on 15 September 2013 and the Independent Evaluator visited the service point/organisation on the same date. Interviews were conducted between 12 and 28 August 2013. A post evaluation discussion was held on 11 September 2013 with the Chief Executive Officer.
The Independent Evaluator operates under the Guidelines for Independent Evaluation. The Independent Evaluator was:
Deb Saville
The organisation uses the term clients, children and families to refer to people with disability, family member/s of people with disability, or unpaid carers of people with disability.
NB Under the Carer’s Recognition Act 2004, a carer refers to a person who provides care or assistance to another person who is frail, has a disability, a chronic illness or a mental illness, without payment apart from a pension, benefit or allowance.
2. Acknowledgements
The Independent Evaluator would like to extend thanks to individuals, families and carers for the assistance they provided throughout the evaluation visit.
The Independent Evaluator acknowledges the commitment of the staff in providing services. This was evident from the evaluator’s observations and discussions with individuals, families and carers; observations of staff interactions and discussions with staff; and from the positive comments about staff, the evaluator received from individuals, families and carers.
Findings documented in this report have been selected to support the outcomes of this evaluation and highlight background evidence for good practices, required actions and key
3. Service point profile
The profile provides a brief overview of the service point evaluated. Disability sector organisation: Wize Therapy Pty Ltd
Service point name: Whole of Organisation (Disability Services Commission funded services)
Outlet name: Early Childhood Intervention Chief Executive Officer (CEO): Paula Dyke
Brief description of the service point (including mission/vision statements and brief history)
The organisation was established in May 2007 with a view to providing occupational therapy, physiotherapy and speech pathology services to children and their families, and adolescents and young adults, along with a project/consultancy service to the health and disability
sectors. There are several streams within the organisation that provide services to children and their families; a private stream, families that access services through the Commonwealth initiatives of Better Start and Helping Children with Autism; and compensable clients. Wize Therapy became a provider of Disability Services Commission (the Commission) Early Childhood Intervention services in July 2009, with six places. The Commission funded Early Childhood Intervention service has grown with each growth funding round and now provides services to 42 children and their families.
The three primary therapies of physiotherapy, occupational therapy and speech pathology provide services to families within the service delivery model of family centred practice which is ecologically based. Families receive services in the environment of their choice which may be home, school, child care or centrally at the practice. Liaison with key stakeholders is also fundamental to service provision.
The focus and scope of this evaluation is the Commission funded Early Childhood
Intervention program. Generally, matters of governance and funding are addressed by the Service Contract and Development Officer at the Commission and fall outside the scope of this evaluation.
Resources (eg building/s, staffing, IT systems, vehicle/s, budget)
The direct support staff are physiotherapists, occupational therapists and speech
pathologists. While the total full time equivalent (FTE) staff number is approximately 4.8 there are a number of therapists involved in the provision of services. Two physiotherapists, five occupational therapists and three speech pathologists work on the Early Childhood
Intervention program. The numbers of children do not warrant the employment of a
psychologist and if a family requires this service, psychology services are contracted into the organisation for a finite period.
Up until recently, the Chief Executive Officer coordinated and managed the service. In March 2013 the senior Occupational Therapist (0.6 FTE) became responsible for clinical
governance of the service.
The Assistant Director is responsible for the administrative governance of the Early Childhood Intervention service, including the organisation’s internal database (Disability Professional Services Register) and other governance matters. The therapy team is supported by administration staff and a therapy assistant.
The service budget for the Early Childhood Intervention service this financial year is $400,429.00. Wize Therapy is ‘block funded’ to provide Early Childhood Intervention and follows the funding parameters and Annual Client Data Collection (AC/DC) reporting as required by the Commission.
Brief description of people using services
Of the 42 current places, 23 are occupied by males and 19 are females. The youngest is 12 months old and the oldest is six years old. The therapy support provided varies according to the needs of the child and family at any one time and the goals determined with the child and family. The family is central to the provision of services. The most dominant disability type is global developmental delay, with a small proportion of the children having autism, Down syndrome and cerebral palsy.
The primary stakeholders are child care workers, kindergarten and pre-primary teachers along with local area coordinators.
Consultations
During the evaluation assignment, the Independent Evaluator consulted with 18 family members and four external day care/pre-school/school workers.
Eight therapists, the Practice Manager, Communications and Marketing Manager, Assistant Director and the Director attended the preliminary meeting and all were involved in giving their feedback.
A post evaluation discussion was held with the Chief Executive Officer on 11 September 2013 as no families wished to attend a post evaluation meeting, though some feedback from various stakeholders was received by phone and/or e-mail. The feedback affirmed the draft report.
4. Executive summary
A. Good practices
This section reports the independent evaluator’s findings of the service point’s strengths in relation to addressing outcomes through good practice.
The Independent Evaluator was particularly impressed by:
The fact that many families were eager to contact the evaluator to give feedback, saying they really wanted to acknowledge Wize’s therapy services.
The exemplary feedback received by families about the professionalism, dedication, experience, knowledge and supportive strategies provided by the Wize therapists. Comments included:
o “We feel so very fortunate to have found Wize.”
o “There is no comparison between Wize and my previous provider...Wize is wonderful...awesome...fantastic...approachable...accommodating...more personalised...not an institution...Wize makes us feel like equals.”
o “WIZE staff are...flexible...caring...friendly...efficient...always available...have time for us...treat us as individuals...they love my daughter/son almost as much as I do.”
o “Their planning is excellent...they pulled it all together for us...helped with
funding...they are informative...knowledgeable...patient...up-to-date...keep us well informed.”
The rapport building skills and level of listening abilities of the team, which make families, feel really heard and valued.
The number of comments made by families about how the service has made a difference not only to the child with a disability but the whole family.
There is a high level of trust and several families gave powerful examples of Wize “…going above and beyond their job role.” One example, is offering a family member a place to attend a conference. Another family said that even though they live just outside of the geographic zone for home visits Wize do them because the complex needs of their child means that the therapy works best in the home environment.
The cohesive, dedicated team, and the way that the therapists work together and support the whole family. The therapists are highly motivated but place the child and family in the ‘driver’s seat’ of service design and goal setting.
The innovative use of the Measure of Processes of Care (MPOC) to gauge how family centred the organisation is.
The innovative Goal Attainment Scaling (GAS) used in goal setting. It uses a hierarchy of goals within a goal. The level a child reaches is very clear and often children exceed their set goal.
The commitment and the dedication to providing services to Commission clients, whereby the private part of Wize has subsidised and supported this ‘arm’ of the business.
The working across three environments: day care/kindergarten/pre-school, home and the Wize clinic, is a way to ensure generalisation and transfer of skills occurs.
The creation of two new roles, one to take responsibility for clinical governance and the other for administrative governance.
The new Memorandum of Understanding between therapy service providers which aims to ensure a smooth transition from the Early Childhood Intervention program to School Age therapy services.
Advising parents about the five subsidised sessions available through the Enhanced Primary Care Scheme if they have to be on the waiting list.
The premises and resources.
The level of experience of the director and senior staff.
The fact that Wize have followed up on the suggestions made in the last QMF Quality Evaluation report, making considered decisions that are appropriate for the viability and development of their organisation.
The openness and efficiency of all involved in the evaluation process and the timely manner in which all information was made available to the evaluator.
Wize distributed the draft report to everyone on the Commission client list, which is best practice.
The Director advised that Wize has agreed to be involved in a pilot project with the Commission to identify strategies to assist with ‘waitlist management’, demonstrating interest in sector development.
B. Required Actions
Disability sector organisations are required to meet all contractual obligations of their Service Agreement with the Commission. Required Actions focus on the minimum satisfactory level of service and must be implemented by the specified date. The rating scale used to assess the Disability Services Standards is met/not met.
Based on observations and corroborative evidence examined as part of this assessment, it is assessed that the service point meets all nine Disability Services Standards. The
independent evaluator did not identify any Required Actions during the evaluation visit.
C. Key Priorities for Service Improvement
Key Priorities for Service Improvement identify actions to enhance practices in addressing outcomes for people with disability and meeting Disability Services Standards.
They need to be carefully considered by service management as part of contractual
obligations and normal organisational planning processes, and then implemented. They are required to be reported upon in the next Self Assessment as evidence of continuous service improvement.
The independent evaluator identified the following Key Priorities for Service Improvement:
Key Priority for Service Improvement 1 Early Childhood Intervention All Outcomes
To ensure that all therapists work collaboratively with external providers to maximise the success of therapeutic interventions.
Key Priority for Service Improvement 2 Early Childhood Intervention All Outcomes
To further develop strategies to enrol ‘resistant’ external providers to work collaboratively in the best interests of the children and their families.
D. Matters for further exploration
This section reports the independent evaluator’s summary of other matters arising from the evaluation of the service point.
Several numbers on the database list are incorrect, out of service or not the preferred number. An external stakeholder verified this too. It would be good if Wize could introduce some system that ensures changes in personal details and/or circumstances are passed on and recorded as soon as possible.
A small number of family members and one external stakeholder feel they could be better informed and would like copies of the goals, progress and other information, for example some activities that could be done in the classroom to strengthen the child’s skills. The external stakeholder described how she has ‘backed off’ even though she feels she has much to offer if the therapist was more willing to be collaborative, which she feels would benefit the development of the child. (See KPSI 1)
One family said that the school could be more collaborative with Wize, and asked if Wize could help with this. (See KPSI 2)
One family said that she had been advised by one therapist that Wize does not give out copies of goals. However, as part of Standard 4, families are entitled to see, and request copies of, any information kept about their child(ren), especially goals, plans, progress reports; though not limited to these. All staff need to be aware of the Disability Services Standards, their implications, and give families and external stakeholders correct and accurate information.
Some families commented that when a change of therapist has occurred the ‘handover’ has been well managed and this has led to consistency of service and progress. Four said this was not the case. It would be good practice if consistency occurred.
Some families said that they would like more therapy hours. Two families felt very strongly that there is an unmet need and one of these said that supplementing the therapy by additional private sessions was financially compromising. The Director advised that ongoing discussions with families are always welcome to assess and re-assess needs. Three family members asked if Wize would open up a centre in the northern suburbs. It
would be useful for families to know Wize’s response to this.
Four families suggested that Wize consider providing School Age Therapy services. It would be useful for families to know Wize’s response to this.
Wize’s strategic planning will consider expansions when the current service provision has been consolidated.
Although funding is a matter that is outside the scope of this evaluation some families would like the funding guidelines to be reviewed and the parameters for how funding can be spent to be more flexible. Many said that the current rules are a barrier to the
Outcomes, particularly the participation outcome. Therapists and families are keen to see the results of the ongoing review of the Community Aids and Equipment Program (CAEP) guidelines and hoping that they further foster community inclusive practices.
One external stakeholder contacted the evaluator and had not received a copy of the draft report. It would be good to make sure that all external stakeholders receive it.
5. Meeting outcomes
This section reports the independent evaluator’s findings of the service point’s achievements in relation to addressing the outcomes.
Meeting outcomes: Disability professional services General Comments
This service is outstanding, with many aspects of best practice, including: professionalism, up-to-date research and methods, genuine care, going beyond just the job, excellent
leadership, well organised and managed services, flexible and approachable and a dedicated staff who really listen. See also comments in ‘Good practices’ on page 5.
Twelve family members gave a satisfaction rating of eight, nine or ten out of ten about their experience of Wize services. One gave a rating of 20 out of ten and two rated their
satisfaction at either five or six. Four people said that the services offered by Wize and their genuine, caring approach had made a huge difference and were life-changing, not only for the child with a disability but the whole family. Some families highly value how Wize involves siblings in ways that enhances the therapy.
Four family members commented that they value the senior therapists who they feel are very experienced. One family member said that she appreciated the very young therapists who bring a dynamic, fresh, vibrant energy that makes therapy seem more like a fun learning experience, making her and her child ‘forget the disability’.
The services are family centred and the goals are in accordance with the person centred approach. The family decide upon the goals, which are written in a family-friendly way in the initial/review meeting notes. The therapists then use their innovative Goal Attainment Scaling (GAS) tool to create a hierarchy of goals within a goal. As a result of this process the
therapists are extremely clear on the purpose of each goal and can concisely and accurately determine the level of success each child has with each goal. Records show that children often exceed the expected outcomes. Families verified this. However, some said that they cannot be sure that the progress is solely the credit of the therapy or an amalgamation of many factors.
Independence
Outcome: The individual’s independence in daily living is maximised. Evidence noted (eg observations, feedback and documentation):
Families and the external staff gave the following examples of the differences that Wize Therapy is making to the childs’ independence:
o “S/he has caught up by almost two years in a very short timeframe.”
o “S/he is now making milestones we (and the doctors) never thought possible.” o “S/he is vocalising more, uses more words, can speak two word utterances.” o “S/he says more...and understands more.”
o “S/he is developing skills that they did not have, for example, waves
goodbye...holding items...vocalising more...crawling...walking...riding a trike...trunk stability...muscle tone...mobility...fine motor skills...dressing skills.”
o “S/he can make her/his needs known, which has reduced his/her frustration and my stress.”
o “S/he has developed climbing skills.”
o “S/he is more determined to try and be independent.”
The documented assessments, checklists, goals, session plans and progress notes all support the above comments.
One file included a child’s ‘work samples’ which showed the progress being made. Families all felt that they were enabled to express the goals that they wanted the
therapists to work on with their children. They also felt that the therapists made very appropriate and relevant suggestions where they saw this as adding to the child’s goals and/or skills/development. One family commented that the relevance of the goals and the environment that they were carried out in was priceless.
Summary of evidence
All service provision delivered is addressing the Independence Outcome. The families are highly satisfied with Wize Therapy. Two instances of improving even further are described above.
Participation
Outcome: Participation in everyday life in usual settings.1
Evidence noted (eg observations, feedback and documentation):
Families and the teacher shared the following examples of the differences that Wize Therapy is making:
o “S/he now looks forward to going to the therapy sessions...and to other groups...and participates better in class activities.”
o “S/he now takes an active part in things, whereas s/he did not do this before.” o “We as a family feel supported and better able to cope...his/her frustration is
reduced...and so has my stress."
o “Gross motor skills...fine motor skills...communication...concentration...are
improving...which means s/he is better equipped to take part in group situations (in the family, the community and at pre-school/kindy/day care) and mainstream activities.”
o “S/he has increased speech development and is quicker to express her/himself.” o “S/he has grown in confidence.”
o “S/he interacts more with the family now...especially with her/ his brother/ sister...s/he mingles with others his/ her own age now...has more friends now...s/he initiates play now.”
1Usual settings are environments of choice available to anyone of similar age, within the constraints of our civil society and the individual’s resources.
Activities include the range of relationships and social connections needed for successful participation within those settings.
o “S/he is happier...so we are happier.”
o “The ‘talker device’ has helped her to join in family prayers.”
o “WIZE have settled him/her into kindy...s/he is now following instructions...showing an interest in toys; other children.”
o “S/he can participate in day care now using Makaton signs with the day care worker.”
o “I have some independence because I can now leave him/her with others.” The Director said that sometimes WIZE runs groups that parents and children attend
together and share experiences and therapy sessions in a group setting. Examples include ‘mum’s group’ and ‘kindy group’. Family members said that they get to meet other families and that being able to socialise and chat is very helpful. This is the case in formal groups as well as informally at the WIZE premises.
Several family members said that WIZE therapists often involve the siblings and this helps to develop participation.
One family said that the WIZE Risk Assessment of the playground equipment helped to educate the school staff.
The documents clearly show the goals, actions and progress made.
Summary of evidence
Services provided are addressing this Outcome in ways that have been described as life-changing for the child with the disability and the family unit. Family feedback, documentation and feedback provided by some external staff supported these findings.
Progression of the CAEP Guidelines to more fully foster community inclusive practices for and with people with disability is required as some of the current guidelines limit this
Outcome. A review is underway and it is hoped that this will bring results that more positively impact the Outcome and the lives of people with disabilities.
6. Compliance check
Standard 8: Service management (running the service well)
Supporting Standards 8.1 and 8.2: The service provider conducts police clearances and provides a safe physical environment for its consumers (operating a safe service)
Observation Yes No N/A Info
source The service provider conducts National Police checks for
Board members, staff, volunteers and contractors prior to commencement.
Y 1,2,5
National Police checks are regularly updated for Board members, staff, volunteers and contractors.
Y 2,3,5
The service knows what to do if an unsatisfactory National Police check is received from a Board member, staff, volunteer or contractor.
Y
2
The service has an emergency evacuation plan. Y 5
The service regularly practises its emergency evacuation plan. Y 2
The service keeps records of evacuation trials. Y 2
The service has policies and procedures on the administration of medication.
Y 5
The administration of medication occurs as detailed in the policies and procedures instructions.
Y 5
The buildings are maintained in a condition that does not pose a risk to service users.
Y 1
Information source legend: 1 direct observation; 2 discussion with management staff; 3 discussion with direct care staff; 4 discussion with consumer/s; 5 documentation; 6 self assessment; 7 Commission staff; 8 not determined.
All staff have police clearances as well as the Working with Children checks.
WIZE comply with the building Fire Policy as well as running ‘WIZE-specific’ fire drills. The WIZE medication policy is that staff do not administer medications.
The Director advised that WIZE has agreed to be involved in a pilot project with the Disability Services Commission to identify strategies to assist with ‘Waitlist Management’. The database is easy to access and it is also easy to generate a variety of reports, for
example:
o to track direct hours delivered o therapist hours
o which disciplines have been used by each client o hours used at any given point year-to-date o annual figures
o indirect hours (eg travelling, meetings, report writing)
WIZE staff would like to be able to produce reports that give a specific breakdown of how indirect hours have been used and are working on this.
Standard 9: Protection of human rights and freedom from abuse and neglect: being protected from harm
Observation Yes No N/A Info
source Supporting Standard 9.6: The service provider has procedures
in place to respond within seven days to allegations of abuse and neglect, including reporting mechanisms and strategies for protecting people with disabilities from abuse.
Y 5
Information source legend: 1 direct observation; 2 discussion with management staff; 3 discussion with direct care staff; 4 discussion with consumer/s; 5 documentation; 6 self assessment; 7 Commission staff; 8 not determined.
Everyone feels safe at WIZE; and when in sessions with WIZE therapists wherever they are held.
The Director advised that the Disability Services Standards are discussed at staff meetings. The Director agreed that it might be useful to include a discussion about the case study scenarios to add further depth to staff knowledge. Case study scenarios are in the Disability Services Commission’s Standard 9 Training Manual, which is available from the Commission and on-line on the Commission’s website.
7. Appendix
A. How the quality of your service is measured
Quality Evaluation
Independent evaluator contracted to the Disability Services Commission collect evidence from multiple sources to verify the quality of services and supports provided.
People with disability, their families and carers are invited to comment through the evaluation process on the services and supports they use and how well they are being enabled to live a good life.
Management and staff and other interested stakeholders are invited to
comment on the services and supports provided and outcomes being achieved. Evidence is collected by an evaluator and assessed in relation to both Quality
Management Framework outcomes and compliance with the Disability Services Standards2. The evaluation also provides opportunities for suggested
improvements to be made.
Outcomes
Outcomes refer to the impacts, benefits or changes that people with disability, their families and carers experience as a result of using a service or support. Outcomes also identify what people with disability, their families and carers can
expect from a service or support.
The outcomes and performance indicators have been developed for each service type: accommodation support, advocacy, alternatives to employment, disability professional services, family support, local area coordination and recreation. Examples include wellbeing; independence; relationships and social connection; lifestyle of choice; and community inclusion and participation.
Performance indicators
Performance indicators describe what is looked at to decide how well the service is doing in supporting people with disability, their families and carers to achieve good outcomes.
Satisfaction is defined, in the context of quality evaluation,as a comparison between what a person feels/expects service standards ‘should be’ and their experiences of the ‘actual service’.
The best disability sector organisations are those that progressively improve services and supports to enable people with disability, their families and carers to achieve beneficial outcomes. The quality evaluation supports this to happen.
2
Quality Management Framework outcomes and Disability Services Standards are under review for updating and consolidation.
B. Disability Services Standards
Standard 1 Service access:getting disability services
Each consumer seeking a service has access to a service on the basis of relative need and available resources.
Standard 2 Individual needs: getting the right help
Each person with a disability receives a service which is designed to meet, in the least restrictive way, his or her individual needs and personal goals.
Standard 3 Decision making and choice: having choices and making decisions
Each person with a disability has the opportunity to participate as fully as possible in making decisions about the events and activities of his or her daily life in relation to the services he or she receives.
Standard 4 Privacy, dignity and confidentiality:keeping things private
Each consumer’s right to privacy, dignity and confidentiality in all aspects of his or her life is recognised and respected.
Standard 5 Participation and integration: being part of the community
Each person with a disability is supported and encouraged to participate and be involved in the life of the community.
Standard 6 Valued status:valuing each person
Each person with a disability has the opportunity to develop and maintain skills and to participate in activities that enable him or her to achieve valued roles in the community.
Standard 7 Complaints and disputes: sorting out problems
Each consumer is free to raise and have resolved any complaints or disputes he or she may have regarding the service provider or the service.
Standard 8 Service management: running the service well
Each service provider adopts sound management practices which maximise outcomes for consumers.
Standard 9 Protection of human rights and freedom from abuse and neglect:being protected from harm
The service provider acts to prevent abuse and neglect, and to uphold the legal and human rights of consumers.
C. Disclaimer
The evaluation assessment is necessarily limited by the following:
The methodology used for the evaluation has been designed to allow a reasonable degree of assessment in all the circumstances, particularly cost effectiveness of the evaluation
process.
The standards against which assessment is made involve subjective terms and this entails an exercise of subjective judgement.
The assessment involves a reliance on multiple sources of evidence, including observations, feedback and some written records. The accuracy of written records cannot always be completely verified.
Where outcomes for individuals are of a high standard, and observation and other evidence indicates no apparent gaps in meeting the Disability Services Standards, the Standards are deemed to have been met.
The assessment will often involve a determination as to which of two or more versions of the same facts put to the evaluation team is correct under circumstances where this issue cannot be determined with absolute certainty.
The assessment will involve the evaluation team raising issues with a sample of individuals with a disability, their family members and carers. On some occasions information gathered from a sample will not reflect the circumstances applying over the whole group.
For these reasons the evaluation team cannot and do not accept responsibility for the veracity of any information on which they have based their reports and for a subsequent incorrect assessment that may have occurred based upon that information.
