6. Conduct a standards of care review - care services

This section outlines the procedures for responding when a standards of care review is recorded in relation to a child in care and placed with a care service.

Child Safety will conduct a standards of care review to determine if the standards are being met, and where not met, what actions are required to meet the standards and improve the level of care provided to the child. Child Safety will work collaboratively with care service staff to conduct the review.

A standards of care review is different to the investigation and assessment of a harm report. A standards of care review is not an investigative response that utilises a forensic approach, and formal interviews are not to be conducted.

Key activities

The key activities for completing the standards of care review include:

  • having the standards of care discussion with the manager or co-ordinator and other relevant staff members of the care service
  • talking with the subject child to understand their experiences in the placement
  • exploring and analysing the broader context of the child’s placement, to identify factors that contributed to the standards of care being not being met, if required
  • assessing the information to determine an outcome
  • developing an action plan to improve the standards of care provided to the child, where required.

Note: When a standards of care review is recorded, there is no obligation to advise the child’s parents of the concerns. Practice considerations may apply, and discussion with the senior team leader will assist to identify the level of information that could be provided to parents.

6.1 Plan the standards of care review

Prior to commencing the standards of care review, develop a plan for addressing the key activities of the review, in partnership with the care service, the CSO with case responsibility for the subject child, the senior team leader, senior practitioner and the regional team responsible for funding and contract management of the care service.

The CSSC responsible for the standards of care review will lead the planning process. While some of the required decisions may have already been made during the initial consultation process with key stakeholders, the purpose of planning is to determine the following:

  • which staff members of the care service can provide relevant information
  • who will be responsible for discussing the standards of care with the identified staff members
  • who will be responsible for talking with the child
  • what additional information is required and how it will be sourced
  • the responsibilities for each person involved in completing the review
  • plans for responding to issues and difficulties that may impede the review process.

The planning process must ensure that the following commencement and completion timeframes can be met:

  • commencement within five working days - a standards of care review is commenced when either the discussion with relevant care service staff occurs, or when the child is talked to about their placement
  • completion within four weeks - a standards of care review is completed when the care service has been advised of the outcome of the standards of care review and where applicable, an action plan has been developed.

The Standards of care review checklist is available to assist staff in the review process.

The standards of care review discussion with the care service

As part of the planning process, seek the advice of the co-ordinator or manager of the care service about:

  • arrangements for discussing the concerns with them and other relevant staff members
  • suitable arrangements for the face-to-face discussion with the child
  • access to relevant procedures or training documentation, where relevant.

Decide who will talk to the child

It is preferable that the child be engaged in an informal discussion with a CSO with whom they are familiar. Where there are multiple subject children, the senior team leader from the CSSC responsible for the standards of care review will negotiate who will be responsible for having the discussion with each child.

As part of the planning process, consider and decide the following matters:

  • who will talk to the child and the location for this discussion
  • the arrangements to provide the child with a support person, should they elect to do so, and provide the child with a copy of the Information sheet for children and young people (PDF, 178 KB)
  • where there is more than one CSO, how the child’s information will be documented and provided to the allocated CSO.

Record the standards of care review plan

Complete the review plan section of the Standards of care review report in ICMS and include:

  • the outcomes of consultation between Child Safety staff and the care service
  • the decisions made in relation to the standards of care review plan
  • the actions to be undertaken, including who is responsible and the timeframes for their completion.

Seek the senior team leader’s approval of the plan and ensure that all relevant persons are aware of their responsibilities for the activities of the review.

6.2 Conduct the standards of care review

Commence the standards of care review

The standards of care review is commenced when there is a face-to-face discussion with either the subject child or the care service about the standards of care. Commencement will occur within five working days of the response decision.

Guiding principles for the review process

The purpose of a standards of care review is to determine whether or not the standards have been and are being met. The principles guiding the review process are:

  • recognising that the responsibility for the provision of quality care to the child is a shared responsibility between the care service and the department, and that there is a need to explore the broader context of the care team responsibilities that may have contributed to standards of care not being met
  • using an inquiry and strengths based approach rather than an interrogative or blame approach - for further information, refer to practice resource Standards of care - key concepts and definitions (PDF, 26 KB)
  • providing the child with a voice in the process in a way that respects that their best interests are the central focus of the care team
  • having a collaborative and flexible process to completing the key activities of the review so that the best outcomes for the child can be achieved
  • ensuring that the care service receives assistance to address any concerns about the quality of care that is being provided.

Human resource matters

For care services licensed by Child Safety, the care service licensee is responsible for ensuring the suitability of employees. Child Safety will not make decisions on behalf of the care service about human resource arrangements, for example, suspending or terminating the employment of a care service employee. However, where there are concerns about a particular staff member, Child Safety will raise the concerns with the care service manager or coordinator for their appropriate action.

The regional team responsible for funding and contract management will provide the care service with support on taking actions that comply with the relevant licensing requirements.

Discuss the standards of care with the care service

The review discussion will focus on the standards of care that require review, using the guiding principles outlined above. To ensure a fair and transparent process, the care service will be given information about:

  • the standards of care that are under review
  • the presenting issues or concerns that support the need for the review
  • the purpose of the review
  • the timeframes and possible outcomes of the review.

The discussion will be undertaken in a collaborative way, to ensure sufficient information is discussed with care service staff to enable an outcome to be determined.

A clear discussion with care service staff about the standards of care being provided to the child will:

  • establish the understanding of staff about the specific standards of care being reviewed and how staff apply the standards in their daily care of the child, including how they are supported in their role
  • allow care service staff to provide their own account of the circumstances surrounding the presenting issue or concern that gave rise to the review and any unmet need for the child
  • encourage care service staff to discuss their experience of supporting the child, including both the challenges and successful experiences
  • identify the actions or inactions of care team members that contributed to the child’s care not meeting the standards of care
  • explore any areas of unmet need for care service staff.

When talking to care service staff, use questions that will allow discussion of situations when the standards of care have been met and, if applicable, not met for the child. Assist staff to identify what they may do in a similar situation, to help them identify their capabilities and needs, and what assistance is required to enable them meet the standards of care in future.

Discuss the standards of care with the child

The discussion with the subject child will be managed in a way that minimises the trauma to the child. Formal interviewing of the child, particularly in their school environment, is notappropriate.

The purpose of talking to the child is to ensure they are given the opportunity to be heard regarding their experiences in the current care environment.

The face-to-face discussion with the child must not occur in the presence of care service staff. Use broad, open-ended questions that encourage the child to talk, exploring both the positive experiences in their care environment and concerns about their care environment.

As part of the discussion, the child will be:

  • provided with information in a child friendly and age appropriate manner
  • given the opportunity to express their views, experiences and wishes about their current placement
  • supported by another appropriate person during the discussion, if they request this, to facilitate their participation. Refer to the Information sheet for children and young people (PDF, 178 KB).

Concerns about the appropriateness of the placement for the child

If at any stage of the review it becomes apparent that the placement is no longer in the best interests of the child, the CSSC manager can make the decision to move the child to another placement. In this circumstance refer to Chapter 5, 3. What if a child is to be removed from an out-of-home care placement?

Analysing and assessing the information

A holistic assessment requires that a broad range of factors be considered prior to reaching an outcome to the standards of care review. This recognises that the care service is one part of the child’s care team, and that the actions or inactions by others can also impact on the standards of care provided to the child.

In addition to the discussions with the child and care service staff, consideration of the systemic context in which the care to the child is occurring is required. This widens the focus of the assessment to allow the identification of actions and inactions by either the care service or Child Safety, where these may have contributed to the concerns. These considerations will include, but are not limited to:

  • whether the child’s placement was and continues to be appropriate for the child at this time
  • whether the support and supervision of staff has been adequate, taking into account the level of experience of care service staff and the complexity of the child’s needs
  • the frequency, adequacy and nature of contact by the CSO with the child and the care environment
  • whether the key activities in the child’s case plan are being actioned in a timely and responsive way by the CSO and other members of the care team
  • the progress of actions following the outcomes of previous standards of care reviews or harm reports, where applicable
  • the presence of additional stressors in the care environment such as a new placement, or conflict between other children in the care environment, or issues with the management of the child’s challenging behaviours.

6.3 Decide the outcome

To determine an outcome for each subject child to the standards of care review:

  • consult with the senior team leader and senior practitioner
  • provide the care service with an opportunity to contribute their views, where they have had an active role in the standards of care review
  • take into account the contextual and systemic factors specific to the care service that have impacted on the child’s care.

There are two possible outcomes to the standards of care review:

1. Standards met

This outcome is recorded when the information from all sources has been analysed and it is determined that the care provided to the child is in accordance with the standards of care, and there is no indication that the child has experienced harm.

2. Standards not met

This outcome is recorded when the information from all sources has been analysed and it is determined that the care provided to the child has not met the standards of care, and there is no indication that the child has experienced harm. In reaching this outcome, the specific standards of care that have not been met, as outlined in the Child Protection Act 1999, section 122, must be identified.

When this outcome is recorded, the identification of a ‘person responsible’ is not required, even though specific actions may be required to ensure the standards of care are met in the future.

This reinforces that a partnership approach is required to ensure the standards of care are being met for the child, and that failure to meet the standards may be due to the actions or inactions of care service staff, or any other member of the care team with monitoring responsibilities under the Child Protection Act 1999, specifically the care service and Child Safety.

When the outcome is ‘Standards not met’:

Actions required when harm or suspected harm becomes apparent

If during the assessment of the standards of care review, it becomes apparent that the child has experienced harm or it is suspected that they have experienced harm, immediately discuss the information with the senior team leader and senior practitioner. The decision to record a harm report will be made by the CSSC manager.

In this circumstance, record the information in relation to the harm in the open ‘Standards of care review report’ and identify harm in the Outcome decision section of the report. A Harm report will be automatically created in ICMS. Following this, respond in accordance 7. Investigate and assess a harm report.

6.4 Advise relevant parties of the outcome

When the senior team leader responsible for the standards of care review has approved the outcome, provide verbal advice of the outcome to:

  • the manager or co-ordinator of the care service, who will then advise the staff members involved in the standards of care discussion
  • the subject child, where age and developmental appropriate
  • the CSO of all children placed with the care service.

When the outcome of the standards of care review is ‘Standards not met’, provide written advice of the outcome to the manager or coordinator of the care service, using the Letter to care service - standards of care review outcome. Provide a copy of the outcome letter to:

  • the regional team with responsibility for funding and contract management
  • the director of the PSU.

6.5 Record the standards of care review

To finalise the record-keeping for the standards of care review:

  • record the information gathered during the standards of care review, the assessment and recommended outcome in the 'Standards of care review report' in ICMS
  • seek senior team leader approval for the ‘Standards of care review report’ in ICMS which will close the event.

In addition, alert all parties to applicable complaints and review mechanisms. Refer to 7. What if a person wants to make a complaint or seek a review?