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Community Justice Program

Service Model Description

Individualised Support: Tailored Support Packages

Ageing, Disability and Home Care

Family and Community Services NSW

Version 3

June 2015

Community Justice Program, Service Description: Tailored Support Package, June 2015

Document Approval

The Community Justice Program: Program Guidelines, Version 3 have been endorsed and approved by:

________________________

A/Director

Community Justice Program

Approved: June2015

Signature on file

_______________________

Executive Director

System Development and Reform Approved: June 2015

Signature on file

Document version control

Distribution: FACS Districts

ADHC Directorates

CJP Service Providers

Document name: Community Justice Program: Service Description

Tailored Support Packages

Version: 3.0

Document status: Updated June2015

File name: Community Justice Program: Service Description

Tailored Support Packages

Authoring unit: Community Justice Program

Date: June 2015


Table of contents

1 PURPOSE OF THE SERVICE MODEL DESCRIPTION 5

2 COMMUNITY JUSTICE PROGRAM

2.1Aim of the Program 5

2.2 CJP Practice Model 5

3 CJP SERVICES

3.1 Overview of Services 7

3.2 CJP Clinical Teams 7

3.3 CJP Accommodation Support Services 8

4. SERVICE DESCRIPTION

4.1 Definition of the CJP Tailored Support Package 8

4.2 The TSP Service User 9

4.3 Duration of Stay 12

4.4 Service Provision Principles 13

4.5 TSP Practice Support Model 13

4.6 TSP Service Provision 13

4.7 Staffing 16

4.8 Working with Aboriginal Service Users 17

4.9 Day Program and Activities 18

5. CJP WORKING WITH SERVICE PROVIDERS

5.1 CJP Involvement 18

5.1.1 Transition 19

5.1.2 Training 19

5.1.3 Tertiary Support 19

5.1.4 Clinical Support and Treatment 19

5.1.5 Offence Risk Management and Monitoring 20

5.2 Other Specialist Support Services 20

5.3 CJP Case-management and Individual Planning 20

5.4 Documentation Provided to the Service Provider 21

5.5 Key Roles and Responsibilities 22

6 THE TAILORED SUPPORT PACKAGE 6.1 Determining the TSP 22 6.1.1 Initial Allocation of a TSP 22 6.1.2 Allocation of the Specific Support within the TSP 23 6.2 Types of Supports to be Purchased 23 6.3 TSP Funding 24 6.4 Over-cost Packages 24


6.5 Costing the Package 25 6.6 Banked Hours 26 6.7 Client Expenses 26 6.8 Annual Review of Support Package 27 6.9 A Guide to Modelling a TSP 27 6.10 Key Features of a Support Package 28

7 ACCOMMODATION ARRANGEMENTS

7.1 Accommodation Options 29 7.2 Paying Rent 30 7.3 Residential Tenancy Agreements 30 7.4 Type of Accommodation 30 7.5 Specific Accommodation Requirements 30 7.6 Managing the Accommodation 31 7.7 Property Modifications 31 7.8 Set-up of Accommodation 32

8 SERVICE OUTCOMES

8.1 TSP Outcomes 32 8.2 Service User Outcomes 32

9 CJP SERVICE PROVIDERS

9.1 TSP Service Providers 34 9.2 General Requirements 34

10 CONTRACTUAL ARRANGEMENTS AND MONITORING 10.1Funding Agreement 36 10.2 CJP Partnership Agreement 36 10.3 Performance Indicators 36 10.4 Minimum Data Set 37 ____________________________________________________

Tables

1: Service Management Responsibilities and Activities 14

2: Support Co-ordination Responsibilities and Activities 14

3: Service Provider Clinician Responsibilities and Activities 15

4: Direct Support Responsibilities and Activities 15

5: Example of CJP Tailored Support Packages :January 2012 27

6: Accommodation Responsibilities and Activities of the Service Provider 31

7. TSP Service Outcomes and Indicators 33

Diagrams

S1: CJP Practice Model 6


1 PURPOSE OF THE SERVICE MODEL DESCRIPTION It is intended that the Tailored Support Package (TSP) Service Model Description

provides an overview of this service model which is one of four that operate under

the Community Justice Program (CJP). It should be used as a compendium to the

Community Justice Program (CJP) Program Guidelines.

The CJP Program Guidelines provides details of the Program’s aim, practice model,

governance structure, service structure and operation. It is imperative that all

organisations and their staff involved in CJP providing services understand the

uniqueness of the Program, people and services in order to achieve the Program’s

aim.

2 COMMUNITY JUSTICE PROGRAM

2.1 Aim of the Program

Each CJP service must operate to meet the primary aim of the CJP, that is:

To reduce offending by people with an intellectual disability who have

exited a correctional centre as they move into the community.

Community integration can be achieved by providing person-centred pre- and post-

release clinical and case management services and specialist accommodation

support.

The CJP support services use an evidence based disability and forensic practice

model to work with the person with an intellectual disability who offends based on

their Strengths, Needs, Risks and Goals. This approach is used consistently through

each of the service components of the Program, that is:

Accommodation

Behaviour Support (clinical services and treatment programs)

Case Management

By providing appropriate support in these key areas the CJP aims to achieve

improvement in Service User’s offending behaviour and quality of life with a view to

living as independently as possible, over time.

2.2 CJP Practice Model

The practice model for the CJP is a specialist disability services model where the

cognitive and functional needs of the person with a borderline or mild intellectual

disability are secondary to addressing their forensic or offending behavioural issues

in order to reduce potential recidivism.

The CJP practice model operates on three underlying sets of principles derived from

studies of working with people with an intellectual disability involved in the criminal

justice system. They include: Positive Behaviour Support, the Psychology of

Criminal Conduct and the Good Lives Model of Offender Rehabilitation.


2.2.1 Positive Behaviour Support

This theory provides direction on how a person with an intellectual disability should

be best supported to reduce the incidence of challenging behaviour by assuming that

challenging behaviour is functional, in that the behaviour serves a function for the

person. Accordingly, a comprehensive bio psychosocial assessment is conducted to

determine the function of the challenging behaviour.

The least restrictive alternative should be used to manage the behaviour; and that

positive, as opposed to negative or punishment reinforcement should be used to

manage challenging behaviours.

2.2.2 Psychology of Criminal Conduct

This approach recognises that offending behaviour occurs as a result of ‘distant’

factors like personality predisposition and the learning of criminal behaviour through

social learning. The learning of the behaviour is governed by ‘close’ factors such as

the expectations the individual holds about the behaviour and the actual

consequences in response to the behaviour. The model also directs assessments

and interventions are done using the principles of Risk, Needs and Responsivity.

Risk principle states people should be prioritised for service and intensity of

service based on their identified risk of recidivism using empirical risk

assessment measures.

Needs principle states that intervention should be directed towards those

changeable risk factors for offending shown to be most influential in affecting

risk. These have been referred to as the criminogenic needs, of which seven

have been identified. It also states that this should be done utilising cognitive

behaviour therapy principles.

Positive Behaviour Support

Risk, Needs &

Responsivity The Good Lives

Model

All of life planning

Policy / Legislation

Positive Behaviour

Support

Approach goal

orientated

Personality

development

Actuarial risk

assessment

Evidence based

treatment


Responsivity principle states that criminogenic needs should be addressed

with consideration of those individual factors that can facilitate learning

utilising cognitive-social-learning interventions.

2.2.3 The Good Lives Model

At the core of this model is the idea that the person should be supported to live a

better life by setting and achieving goals and in so doing they have reduced

motivation to offend. As a result their lifestyle will be inconsistent with offending.

People are also more likely to engage with services that are not constantly telling

them to not do things rather aiming to achieve their goals.

The primary objective of the intervention is to provide the offender with the

knowledge, skills and competencies to gain their goals by developing a more pro-

social and adaptive sense of identity which has meaning. This is a particularly

important consideration when working with those with an intellectual disability, who

positive than the identity of ‘being disabled’.

3 CJP SERVICES

3.1 Overview of Services

The CJP service provision is designed to have both specialist casework as well as a

range of accommodation options to maximise the person’s chances of remaining out

of custody and establishing a life in the community that will meet their needs.

It is recognised that most people with an intellectual disability presently in

correctional centres, on release, require a level of support for a short to medium term

in a stable accommodation arrangement. Without this support, there is an increased

likelihood that they will re-offend or become homeless. Historically there have been

limited post-release options for this group, who tend to have a poor tenancy history

and a high rate of recidivism.

3.2 CJP Clinical Teams

There are specialist centrally located Clinical Teams responsible for the provision of

pre- and post-release direct clinical and casework. Once a Service User is placed

into an accommodation service they assume a tertiary role of advising, training,

monitoring and the provision of, and access to, therapeutic treatment programs.

The CJP Clinical staff actively coordinate and support all transitions for the Service

User that is; release from custody to placement in an accommodation support

service then to other services or into independent living over time.

For the initial three to six months of the placement of a Service User into an

accommodation placement an allocated the CJP Clinician is involved with the

Service Provider in transition planning, service establishment, individual planning

and staff training.

3.3 CJP Accommodation Support Services


The CJP accommodation support service models are designed to enable Service

Users to, as their offending behaviours reduce and they develop skills, take

responsibility and control over their lives by transitioning through the service system.

The accommodation service models differ in that they have a diminishing level of

restriction and increased opportunity for independence.

While the aim of CJP is to move Service Users into independent living, it is

acknowledged that a significant number will need to remain in a specific type of

supported accommodation, long term or permanently as needed.

There is evidence1 that an accommodation system that is interlinked and comprises

three support models: intensive, dispersed and an outreach support component, is

the most appropriate model for the management of people with complex behaviours.

The accommodation support service system needs to be flexible to enable

alternative solutions, either back into a more supported environment, or out into a

less restrictive option. Accordingly the CJP accommodation support service models

are:

1. Intensive Residential Support

2. On-site Supported Living

3. Tailored Support Packages

4. Drop-in Support

The CJP accommodation support service system has the capacity to act as a

throughput model, meaning that Service Users can move towards independence or

into the community as their skills develop, their support needs permit and their risk

behaviours reduce. It is also noted that all Service Users will not necessarily move

through each service model as they acquire increased independence but may go

from one directly into independent living in the community.

There are detailed Service Descriptions for each of the above CJP service models.

This is the Tailored Support Package Service Description.

4 SERVICE DESCRIPTION

4.1 Definition of the Tailored Support Package

The Tailored Support Package (TSP) is both a transitional and medium-term service

model that provides part-time, drop-in support staff for an individual Service User

who lives semi-independently in any accommodation arrangement and geographic

location.

The individual package of support is flexible and can range provide up to the

equivalent cost of a residential placement or no more than 50 hours per week of paid

1 Hill et al (2002) Everyone Needs Good Neighbours: an evaluation of an intensive project for families facing eviction, Child and

Family Social Work, 7, pp.79-89.


support that is focussed on reducing re-offending behaviours, skills development,

responsible community participation and improvement to quality of life.

The TSP service model offers:

part-time support and supervision that may vary as required;

a variety of support arrangements that may be provided by the Service

Provider, another agency/ies, specialist clinicians or informal (unpaid)

people or organisations:

a package of support that is person-centred and meet specific needs

including behaviour support, personal support, clinical and therapeutic

programs and access to the community: and

the opportunity for semi-independent living in a community setting with a

structure for personal daily programs, as required.

Further considerations that need to be taken into account are whether:

the Service User is able to live for some time in a day and of a night

without paid staff present and with an upper limit of formal paid support

and supervision of no more than 50 hours per week with an absolute

maximum of 70 hours;

the Service User demonstrates high risks and requires constant

supervision and support and if so there must be a guarantee of informal

support being available for the period when paid support is not available;

the accommodation facility is usually provided by Housing NSW or Office

of Community Housing, and the eligibility for social housing is that the

person:

has a low income and if in a family household is vulnerable with

affordability problems;

has a disability and needs supported housing; and

must be able to meet the requirements of a Residential Tenancy

Agreement such as paying rent, not disturbing neighbours unduly and

looking after the property with support.

the Service User is, for the most part, ambulant and does not require high

levels of daily physical support.

4.2 The TSP Service User

The CJP is for people with an intellectual disability and who are in contact with the

criminal justice system. Their contact with the criminal justice system is such they

may be described as:

1. a single occasion offender; or

2. a regular offender .


They will have spent time in custody and have established and continuing contact

with the criminal justice system.

When a person has been incarcerated and subjected to a highly structured life for a

significant term, on release they may require an ongoing structured routine and

lifestyle. They may feel insecure without constant support and display vulnerability.

Initially they require structured daily regimes, programs with the aim of increasing

self-esteem, confidence, decision making as well as living skills.

Each CJP Service User is unique. Generally speaking, they will have low to moderate functional support needs and display high or very high risks and complex behaviours due to a range of factors.

The Service Users that may be placed in a TSP often display a combination of these factors:

a transient lifestyle;

dislocation from their family, community or society;

a dual diagnosis (mental illness and intellectual disability);

limited education;

act impulsively or lack of discernment in making decisions;

experienced abuses in their childhood and past ; and/or

display health issues, possibly had or have drug and alcohol dependency

The TSP model is particularly suitable for: 4.2.1 Service Users who display high to complex risk behaviours

A Service User who poses a high to very high risks of offending and requires

a support solution that cannot be met by an alternative CJP service (Intensive

Residential Support (IRS) or an On-site Supported Living (OSSL) due to the

complexity of the behaviour, potential of harm to others, geographic location

or cultural appropriateness.

The complexity of evident issues/conditions that impact the Service User are

such that a specialist support approach is required and may not be within the

capacity of an alternative service to provide.

4.2.2 High Risk CJP Service User to step down

The TSP is a suitable model for Service Users who are initially placed into an

IRS or OSSL due to their high to very high risks and support needs and have

been recently assessed as having sufficient independent living skills and a

reduction in offending behavior to enable them to move into a less restrictive

option, with a greater access to the community yet still have a high level of

supervision and support.

4.2.3 Vulnerable Service User who has high to very high support needs


The Service User who acts impulsively and whose vulnerability is a major

factor in bringing them to the notice of the criminal justice system. They are

often taken advantage of by others and lack confidence and decision making

capacity. Also they are often financially vulnerable and unable to maintain

housing/tenancy or develop supportive networks without assistance.

There are also some Service Users where there is a high probability that they

may experience heightened or adverse behaviours or risks if they live with

others. Conversely, there are Service Users who may impose heightened or

adverse behaviours or risks if they live with others.

4.2.4 Culturally and Linguistically Diverse (CALD) Service User who has high

to very high support needs

The TSP person-centred support packages are also suitable for people from

CALD backgrounds where a culturally responsive service can be designed

and delivered to meet specific needs. The risks associated with the offending

behaviours should be high to very high otherwise a Drop-in Support (DIS)

model may be better suited.

4.2.5 Young Aboriginal Service User who has high to very high support needs

Aboriginal young people make up less than 2% of the general population

aged 10-18 years2 however there is an over-representation of them in the

criminal justice system and on their exit into the CJP.

Trends3 indicate that on any given day there are between 450 and 350 young

people in custody in NSW, of which approximately 35% are Aboriginal. While

new diversionary measures included in the Young Offenders Act have led to a

reduction in the number of people being charged or appearing before the

Courts, there is an uneven application of the Act resulting in an under-

representation of younger Aboriginal young people at the less formal

diversionary end of the juvenile justice continuum and an over-representation

at the more punitive end.4

The impact on the CJP is that approximately 35% of places are filled by

Aboriginal people, many of whom are young people.

The TSP service model is individualised and flexible offering person-centred

approaches and programs. The TSP has the potential to operate in rural and

remote communities and can engage local people, organisations and

partnerships in developing support solutions that are effective and conducive

to Aboriginal young people or adult’s with high risk offending behaviours.

4.2.6 Service Users adverse to services who has high to very high support

needs

2 Standing Committee on Law and Justice, 2000.

3 Annual Reports, Department of Juvenile Justice, 2000-2007

4 Aboriginal Over-representation: Strategic Plan, Department of Juvenile Justice, 2007.


Some Service Users may be placed in this service model because they are

service averse and TSP model is a way of providing a high level of support

and supervision that may be acceptable to the person or their Guardian.

4.2.7 High risk Service Users who has high to very high support needs and

lives with a partner/family

A few high risk Service Users may be in a relationship or be a parent or

expecting a child and may have limited or no support to maintain a stable

living situation, manage day to day activities and make decisions for self and

family. The TSP should be designed to incorporate their additional roles while

maintaining the focus of the package and accommodation tenancy around the

Service User.

Some Service Users may have partnerships that are problematic where

Apprehended Violence Orders (AVOs) are in place and will require

monitoring.

4.3 Duration of Stay

The CJP accommodation service system is designed as a through-put system

enabling Service Users to step down into less restrictive options as they are ready.

The TSP model is regarded as the high support individualised package.

The weekly hours of support for a TSP package are flexible and may be reduced or

expanded overtime depending on the risks and behaviours displayed. The Service

User may stay for:

Short-term stay for a Service User who may require a placement as a

result of a Court Order or be subject of an incident or come to the notice

of the Program or relocation from another accommodation service

requiring an emergency placement. The TSP may be designed to include

an assessment and/or monitoring component as well as providing an

opportunity for them to stabilise before transitioning to back into the

community, appearing in Court or resuming an alternative placement.

Medium term stay: for a Service User who is admitted to the Program with

risk behaviours and for whom there is a high to very high likelihood of re-

offending or harming. Once there is a demonstrated reduction to

offending and risk behaviour and there is evidence to support the potential

of success to live semi-independently, they may step down into a DIS or

other service.

There may be some Service Users who, after a reasonable period are not

engaging in the support offered and there is a mutual decision to exit them

from the service or program.

Long term stay: for a Service User who is assessed as having high to very

high risks and there is an ongoing likelihood of serious offending and or

harming. While living skills and therapeutic/treatment programs are


available, little or no progress is evident in the reduction of risk behaviours

and or skill development.

4.4 Service Provision Principles

The support provided is based on the following principles for the Service User:

Minimal potential to re-offend.

Live as independently as possible but contain risks.

Use the least restrictive support and intervention options unless

authorised.

Case-management/coordination is person-centred, positive and focused

on a Good Life (motivation and reward).

Case-management is assertive and support is active.

Constant monitoring and review of Case/Support Plans for maximum

responsiveness.

Engagement and collaboration with additional expertise to assist with

treatment, skills development and support.

Culturally appropriate support, resources, participation and solutions

provided.

Minimal impact on neighbours and community.

4.5 TSP Practice Support Model

All Service Users will have or be undergoing a Strengths, Needs Risks and Goals

(SNRG) assessment (See Program Guidelines, section 6.3 Support Needs

Assessment) undertaken by the CJP Clinical Team. The SNRG Assessment is a

comprehensive, person-centred evidence-based assessment that captures the key

information about the Service Users offending behaviour including its causal factors,

triggers, risks and potential treatment and management.

An initial Case Plan is formulated from the SNRG Report and includes a Behaviour

Support Plan (BSP) and an Individual Prevention and Response Plan (IPRP). These

plans provide direct support staff, clinicians and service management with details

and strategies in regard to managing the range of behaviours, potential issues and

support needs of the Service User placed in the Service.

The TSPS Service Provider and the CJP Clinical Team develop the Service User

Support Requirements (Support Plan) derived from the initial Case Plan. The direct

support workers, mentors and professional supports as well as an supports are

engaged by the DIS Service Co-ordinator who constantly monitors, adjusts and

reviews the quality and outcomes of the supports provided.

4.6 TSP Service Provision

The TSP Service Provider undertakes four major functions which are:

1. service management,


2. support co-ordination,

3. clinical support, and

4. direct support.

Tables 1, 2, 3 and 4 below summarise the responsibilities and types of activities to

be offered under the four functions undertaken by the DIS Service Provider.

Table 1: Service Management Responsibilities and Activities

SERVICE MANAGER’S RESPONSIBILITY

Specific Activity

Resource and Staff Management and Accountability

Monitoring the implementation of the CJP Partnership Agreement.

Administering and implementing ADHC Funding Agreement.

Reporting and resolving issues/complaints regarding service and Service Users.

Recruiting and managing staff.

Signing Deed of Licence, maintain and monitor accommodation facility.

Negotiating and organise training.

Ensuring service provided is culturally appropriate.

Managing service provision and resources.

Monitoring quality of service provided.

Attending/participating in regular meetings with CJP.

Table 2: Support Co-ordination Responsibilities and Activities

SUPPORT CO-ORDINATOR’S RESPONSIBILITY

Specific Activity

Case Planning and Support

Ensuring compliance with Case Plan and Behaviour Support Plan.

Appointing a Key Worker.

Developing Case Plan/Lifestyle Plan within three months of Service User placement, review quarterly and annually with the Service User/Guardian, CJP Clinician and other stakeholders.

Including household obligations in Case Plan e.g. paying rent, chores etc.

Monitoring and reviewing the Case Plan including all other plans (e.g. BSP, Health Plan etc.), as required.

Implementing and monitoring CJP Partnership Agreement including monthly reporting of Service Users.

Appling all health, medication, epilepsy, risk and financial policies as required.

Maintaining Service User records and data systems.

Negotiating access to other services and monitor.

Manage resources for the appropriate level of support to be provided to the Service User.

Actively participate in quarterly (as a minimum) risk assessments.

Ensuring emergency and safety procedures are in place.

Monitoring and addressing Occupational Health and Safety (OH&S) issues.

Table 3: Service Provider Clinician Responsibilities and Activities


DIRECT CLINICAL

SUPPORT

RESPONSIBILITY

Specific Activity

Behaviour Support

Planning Working with staff to ensure compliance with Case Plan and Behaviour

Support Plan.

Participating in Case Plan/Lifestyle Plan within three months of Service User placement by reviewing and developing BSP.

Identifying any restrictive practices and seek Authorisation, if essential.

Training staff in implementation of BSP including any restrictive practices.

Maintaining Service User records and data systems.

Ensuring emergency and safety procedures are in place.

Behaviour and Risk

Monitoring Monitoring and reviewing the BSP and IPRP as required.

Monitoring and reviewing any restrictive practices.

Participating in quarterly and annual risk assessments and reviews with the Service User/Guardian, CJP Clinician and other stakeholders.

Analysing Incident Reports and data.

Specialist

Collaboration Liaising with CJP regarding behaviour support, therapeutic needs or

treatment programs.

Negotiating access to other professional services, if required and monitor.

Table 4: Direct Support Responsibilities and Activities

DIRECT SUPPORT RESPONSIBILITY

Specific Activity

Managing Behaviour Implementing of risk and behaviour support strategies.

Minimising behaviours that restrict participation in the community.

Minimising behaviours that affect tenancy security and neighbour relations.

Developing and implementing a contingency plan for after hours and emergencies, when needed.

Meeting Legal Obligations

Monitoring and facilitating Court or Parole conditions and/or obligations.

Monitoring Intervention Orders, if in place.

Facilitating and supporting Court appearances, if required.

Decision Making Actively engaging Service Users in choices involving all aspects of their life.

Mentoring in processes for decision making.

Appling a positive mentoring approach to gain an understanding of consequences.

Communication Actively communicating and mentoring in appropriate and effective communication skills.

Maintaining communication books for all staff and Service Users to effectively relate and plan.

Daily Living Teaching and developing independent living skills such as:

planning, shopping, preparation of meals

cleaning, laundry and housekeeping;

caring for personal property and belongings;

organising and maintaining household goods; and


maintaining and caring for property and grounds.

Social Skills and Relationships

Facilitating harmonious and appropriate relations within neighbour and others.

Facilitating contact and communication with significant others i.e. family, advocates and Guardian.

Encouraging social contacts, friendships and social activities.

Tutoring in citizenship, co-operation and living in the community.

Developing and modelling pro-social skills and behaviours.

Personal Care Assessing and addressing skills deficits.

Assisting and monitoring safe and healthy eating and drinking, hygiene, bathing, toileting etc.

Advising on dressing, grooming and presentation.

Community Access Developing skills in travelling independently using public transport.

Encouraging and facilitating the use of community facilities e.g. library, swimming pool, banks etc.

Leisure and Recreation

Encouraging/facilitating participation in sport, recreational and leisure groups.

Facilitating participation in community and adult education.

Day Activities and Employment

Facilitating access to day activities or day programs.

Facilitating/advocating regarding employment, volunteering or other daytime activities.

Health Care Managing and monitoring health issues according to Health Care Policy.

Facilitating fitness, nutrition, sexual health and relationship programs.

Supporting rehabilitation and programs related to drugs and alcohol.

Supporting regular health and dental care regimes and procedures as prescribed and documented by qualified medical and allied health practitioners.

Personal and Financial Accountability

Monitoring and assisting with personal budget and managing finances if required.

Monitoring and assisting with the regular payment of all household and personal accounts.

Maintaining Service User records and ensure data is recorded and kept in an orderly manner.

Making Service User assets safe and monitor their function.

Meeting Tenancy Obligations

Assisting Service Users to budget and pay rent on time.

Monitoring household, neighbour relations and facilitate harmony and issues resolution, when required.

4.7 Staffing

4.7.1 Support Coordination

The Support Coordination/ Case-management function is a critical for the effective

operation of the TSP and is responsible for planning, monitoring and resourcing the

Service User’s Support/Case Plans which requires a flexible and responsive

approach.

4.7.2 Direct Support Workers


The staffing requirement for providing a TSP may comprise a number of different

people with various skills being engaged. The staff engaged by the Service Provider

may work with a number of Service Users in a full-time or part-time capacity.

Staff are required to support the Service User according to their high risk times which

may be weekends or evenings. Each service must have an emergency response

strategy which includes the potential to Call-out additional staff, and/or police, if

required.

While there needs to be a 24 hour a day response available the hours of direct

support will vary from Service User to Service User dependent on their Case

Plan/Support Plan risks, behaviours and needs.

The staff working directly with Service Users with should be trained and experienced

in behaviour support and programming.

Where there are Aboriginal Service Users it is appropriate for support to be provided

by indigenous workers and that community involvement, participation in cultural

activities are encouraged and offered.

4.7.3 Clinical Staff As a specialist service model the CJP TSP requires constant clinical involvement

and monitoring from a Clinician engaged by the Service Provider. A Clinician with a

background in behaviour support will actively monitor the Behaviour Support Plan

(BSP) and Individual Prevention and Response Plan (IPRP) provide programming

and implementation training to direct support staff as required.

4.7.4 Informal support

Some support packages may include the unpaid involvement of family, friends or

other people or community organisations. Informal support should be encouraged

and can lead to reciprocal responsibilities and connection over time.

4.8 Working with Aboriginal Service Users

Aboriginal people are the most disadvantaged group in our community. Their needs

and issues means that the support required is complex and Service Providers must

be aware of how to competently work Aboriginal young people and adults and within

Aboriginal communities. The Australian Government has developed a Culturally

Competent Service Delivery Framework that provides the following principles for

service delivery. These are:

Aboriginal and Torres Islander people are the first Australians with unique

cultures, languages and relationship with land and sea.

There is diversity between Aboriginal cultures and groups.

Colonisation has disposed them of land, and affected families and

communities.

Family relationships are strong and kinship obligations are interwoven as

part of the culture.


Respect for Elders is important and they play an important role in the

community.

Understanding local protocols is essential in service delivery and must

shape the program.

Valid service delivery accurately reflects the preferences and therefore

self-determination is central.

Aboriginal people seek and expect a holistic approach to service delivery.

Effective service delivery will seek to meet the most pressing need for

assistance in a timely and effective manner.

The Opening Doors project t(http://www.yapa.org.au ) provides examples of

strategies for working with young Aboriginal people and gives a three strategy

approach that includes:

1. Find out about the community.

2. Make contact with the community.

3. Work in partnership: joint program are most effective.

4.9 Day Programs and Activities

For CJP Service Users it may not be appropriate to attend group or centre-based

day programs targeted at people with a disability. Most have a high functional level

and their interests may be better served by developing an employment pathway or

further education, training which may provide long term financial and personal

sustainability.

Service Providers (where appropriate and as guided by CJP) should encourage

attendance and participation in training/education and employment outside of the

service and develop day activities for the Service Users by actively engaging with a

variety of business, educational, training and employment providers.

5 CJP WORKING WITH SERVICE PROVIDERS

5.1 CJP Involvement

When a Service User is accepted into the Program they are allocated a CJP

Clinician who works directly with them through the assessment and before

placement in the accommodation support service. The role changes to an indirect

casework role, once they are transitioned. The Service Provider allocates a Key

Worker takes on the direct caseworker role and the CJP Clinician provides an on-

going tertiary role.

The key points of contact between the Service Provider and the CJP Clinician are

described below.

http://www.yapa.org.au/


5.1.1 Transition

The CJP Clinical Team has a prominent role in transition planning and service

implementation. There are a number of Service User transition points in which they

are involved, including:

from entry into the Program to the DIS placement ;

from initial alternative placement to the DIS placement;

from the DIS placement into independent living in the community and

on occasions, from the DIS placement into custody.

Usually the CJP Clinicians have a direct casework involvement during SNRG

Reviews which precedes transitions.

The level of involvement of the CJP Caseworker will depend on the capacity of the

Service Provider to manage the complexity of the support required and how

receptive and responsive the Service User is during the transition into the placement.

The transition period notionally ends at the three or six month period after the

Service User’s placement with the Service Provider and usually marked by the

completion of the first Individual/Lifestyle Plan developed by the Service Provider.

5.1.2 Training

The CJP Clinicians provide training to staff that work with Service Users as part of

establishing the service and at any time thereafter, as required. There is a suite of

training topics that may be offered and tailored to suit the Service Provider and/or

Service User requirements. The Service Provider is expected to facilitate all training

requirements outside of what the CJP offers.

5.1.3 Tertiary Support

During the transition period CJP Clinical staff may work directly with the Service User

and then in a tertiary specialist capacity with the Service Provider thereafter. Tertiary

support may involve providing advice on clinical and direct support or training, and

information in relation to ongoing criminal justice issues.

5.1.4 Clinical Support and Treatment

The ongoing responsibility for behaviour support planning, implementation and

monitoring is with the Service Provider.

Post-transition, it is expected that the Service Provider will take the lead in managing

the Service User and implementing their support including actioning the Behaviour

Support Plan (BSP) and CJP staff will then be available for advice and review.

Treatment programs are essential to address the inherent behavioural patterns and

issues that underlie the offending behaviours. The development of and access to

treatment programs are the responsibility of the CJP Clinicians.

5.1.5 Offence Risk Management and Monitoring


The Assessment of Risk Manageability of Intellectually Disabled Individuals who

Offend – General (ARMIDILO-G) is a structured offence risk monitoring and

management process that examines factors known to significantly influence risk of

general re-offending in people with an intellectual disability . The ARMIDILO-G is

used by the CJP to monitor the risk of recidivism by Service Users once they are in a

placement.

The ARMILIDO-G Tool is completed by the CJP Clinician by interviewing direct

support staff on a regular basis (at minimum on a six monthly basis but ideally every

three months). The results are then feed back to the CJP and Service Provider

management such that recommendations can be included in case/support planning.

5.2 Other Specialist Support Services

Where the Service User requirements are outside the clinical and casework capacity

of ADHC, CJP and the Service Provider such as specialist educational, therapeutic,

neurological, medical or psychological interventions, these may be purchased from

professional practitioners, accessed through Health Services or community

resources or through the use of the Medicare system. The need and cost of these

services DIS support package.

5.3 CJP Case-management and Individual Planning

Once the Service User takes up a placement in a DIS service the CJP Clinical

Team’s case management and planning roles recede and focuses on supporting the

Service Provider to in turn, support the Service User.

The initial Case Plan which is developed from the SNRG Assessment and made

available to the Service Provider is current for three to six months. Within this initial

three months of the placement the Service Provider is required to develop an

Individual Plan/Lifestyle Plan informed by the initial Case Plan and consistent with

ADHC’s requirements for person-centred planning.

With the Service User at the centre, the person-centred Lifestyle Plan will outline:

goals, wishes, hopes and dreams

identified strengths, needs, risks;

support coordination strategies;

agreed support options;

specific transition and exit strategies to or from the service as approved by

the CJP Clinical Team, if required;

roles and responsibilities of those involved in the provision of support and

an evaluation and review of support options in regard to their quality and

effectiveness in meeting needs and goals.

When implementing the Plan the trained direct support staff are expected to actively

and interactively support the Service Users by applying a tutoring and mentoring

approach.


5.4 Documentation Provided to the Service Provider

When a Service User is placed with the Service Provider they will receive six key

documents. These include:

1. CJP SNRG Report which provides a thorough description of the

background and current information about the Service User.

2. CJP Case Plan which is an action plan developed from the SNRG

assessment process. The Behaviour Support Plan is included along

with any current behaviour support strategies that may have been

developed to support the Service User.

3. Risk Profile-Part 1 (CRP 1) which is a one-page Service User risk

profile which is constantly monitored and then reviewed through the case

planning process. This profile is designed for in situ monitoring of

Service User risk and provides a reference for staff to the type of

management plan required for any particular risk (e.g. Behaviour

Support Plan).

4. Risk Profile-Part 2 (CRP 2) accompanies CRP1 and describes the

details of the risk(s) and the management strategies that will be used.

5. Individual Prevention and Response Plan (IPRP) provides staff and

management with further details and strategies in regard to managing

the range of behaviours and potential issues that may arise for the

Service User.

6. Partnership Agreement articulates the respective roles and

responsibilities that CJP and the Service Provider have in regard to

Casework and service delivery. Linked to the Agreement is the Service

User Support Requirements.

Also the Service User’s Guardianship and consent status is discussed and contact

information is provided.

5.5 Key Roles and Responsibilities

The specific roles and responsibilities of the Service Provider and the CJP Clinical

Team are articulated in a Partnership Agreement (see Section 10.2).

Below are the key roles and responsibilities of CJP Clinical Team and Service

Providers.

1. On entry into the Program a CJP Clinician is assigned to commence the

assessment and planning phase.

2. On placement into the TSP, the Service Provider assigns a Case-

manager/Support Co-ordinator and Key Worker to the Service User. The

Key Worker, in conjunction with their Support Coordinator, will schedule and

record case meetings and provide monthly written reports to the relevant

CJP Clinician.


3. The Service Provider maintains regular consultations with relevant CJP

Clinician in relation to the service and support needs of the Service User by:

liaising in regard to the engagement/brokerage of any third party

supports, i.e. in addition to the Service Provider;

reporting on the service provision and agreed actions at case

conferences and special meetings;

implementing the Support/Case Plan as well as any BSPs and data

collection processes;

seeking input regarding the need for, or approval of, any restrictive

practices;

reporting incidents relating to a Service User through line management

in a timely manner; and

consulting as necessary, to obtain agreement prior to planning any

program variation or transition arrangements involving the Service

User.

6 THE TAILORED SUPPORT PACKAGE

6.1 Determining the TSP

The TSP is individually planned and coordinated to meet the needs of the high to

very high risk Service User so that they can live semi-independently in an

appropriate community setting.

There are two aspects to determining the package:

1. initial allocation of a TSP to a Service User; and

2. the allocation of the specific supports within the TSP.

6.1.1 Initial Allocation of a TSP

The configuration of the support package will depend on:

the support needs of the Service User, noting that some will have higher

support needs or risks than others;

the living arrangements proposed that is whether the Service User will live

alone, with family or others;

the availability, configuration and capacity of housing/social housing stock;

access to other formal supports such as therapeutic programs,

employment, day program, health services; and


the potential for the Service User to access and be supported informally

by family, friends or the community.

The support needs of the Service User are considered and determined throughout

the Strengths, Needs, Risks and Goals (SNRG) assessment and case planning

process and prior to the recommend placement into a DIS. During this process an

initial Case Plan is developed from the SNRG assessment. The type and amount of

support required is drawn from the Case Plan and stipulated in the Service User

Requirement document provided on placement into the service which is negotiated

with the Service Provider.

The overall cost and hours of support in the TSP will be determined according to

Section 6.5.

6.1.2 Allocation of the Specific Support within the TSP

The Service Provider will determine and also negotiate the specific supports required

according to the Case/Support Plan with the Service User and/or their Guardian.

The specific supports to be provided according to the Support Plan will depend on:

the type and intensity of specialist or clinical service/s required, eg

counselling, therapy etc;

availability and nature of daytime activities e.g. education, day program,

employment etc;

capacity and capability of the Service Provider to directly provide Activities

of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL);

the nature and level of formal support that can be provided by other

agencies; and

the nature and level of informal support that can be provided by family,

friends/others and the community.

6.2 Type of Support to be Purchased

The different types of supports stated in the Support Plan can be provided directly by

a Support Provider and some may need to be brokered from other agencies or

individuals.

Where support is brokered, formal service agreements between organisations are

required to be in place and monitored.

The types of supports include, case-management, clinical services and various types

of other support requirements e.g. living skills, personal support, vocational support,

recreational support, treatment programs, mentoring etc.

Informal supports are unpaid and may draw on family, friends, clubs, community

groups etc. to be involved in the Service User’s life and support.


6.3 TSP Funding

Unlike some individualised packages models in disability services, the CJP TSP are

not administered by, or allocated directly to, a Service User.

CJP TSPs are accessed and administered in two ways, that is:

1. NGO TSP High Level Support Packages: there are 30 packages

allocated to NGO Support Providers across NSW. These are for high to

very high risk and support Service Users. The value of the TSP is the

equivalent cost of an OSSL place or approximately $122,000 per annum.

This amount provides approximately 55 hours per week or 2865 per

annum of case-management, clinical services and various types of other

support requirements e.g. living skills, personal support, vocational

support, recreational support, treatment programs, mentoring etc.

2. Centralised TSP Flexible Pool: there are up to 60 places that will be

funded by 2016 from a pool of flexible funds held by the CJP for very high

to medium support need Service Users for short, medium or long term

stays.

The funds for these packages are portable and may notionally move with

the Service User between Support Providers in recognition that some

Service Users are itinerate during particular phases in life or due to family

circumstances. In these situations the funds are granted as fixed term

recurrent (for a specified time) and not recurrent.

The cost of a package can vary and will depend on the level of assessed

risk and support needs but as a rule they will average no more than

$100,000 per package but should not exceed the equivalent cost of a

placement in an OSSL service.

These packages may also be used to support short term stays or

interventions for Service Users who have particular high risk issues that

require specialist treatment provided within ADHC or in partnership

arrangements with Government or NGO agencies or programs.

The support hours and funds allocated to any TSP are regarded as flexible and may

be adjusted at least on an annual basis (see below Section 6.8) or if a Service User’s

circumstances and support needs change.

6.4 Over-cost Packages

If a proposed TSP exceeds the benchmark costs stated above, consideration must

be given to the suitability of the service model and the potential to place the Service

in a residential service with full time support available.

Where it is essential, TSP that requires additional funds are to be endorsed by the

Director, CJP and for a time limited period.


If the TSP is over 70 hours per week, it is not viable long term. It must be regarded

as a temporary measure while the Service User’s episode or high risk behaviours

are:

ameliorated through a high level of active case management and clinical

intervention where the outcome is a TSP within costs; or

managed through a high level of active case management and clinical

intervention where the outcome is placement in a suitable 24 hour residential

service that suits the needs of the Service User.

6.5 Costing the Package

Once the Support Plan is converted to a TSP by determining the hours per week of

direct paid support required and costed according to the standard hourly rate of

$43.87 (as of 2011-12).

The standard hourly rate is based on the Attendant Care hourly support cost and is

adjusted annual for indexation.

The hourly rate is the total cost per hour to operate the service and is an all inclusive

amount that covers wages of all paid staff (direct care workers, mentors, clinicians,

other therapists and service co-ordination), on-costs and operational costs

associated with the Package and Service Provider.

The Service Provider is required to deliver at least the total stipulated number of paid

support hours per Service User, per week, over the year.

In addition the funding for the TSP will enable the organisation to deliver its

responsibilities for:

6.5.1 Support Co-ordination

Support co-ordination is not costed separately as a direct support cost and is built

into the standard hourly rate. Each TSP will require at least three hours per week for

service co-ordination and monitoring;

6.5.2 Service Management

The cost of managing the TSP and the contractual arrangements associated with the

package is built into the standard cost per hour as is managing the training recruiting

staff, and assuring professional work practices.

6.5.3 Clinical and Specialist Services

The costs associated with managing the risk behaviours are regarded as a direct

support cost calculated at the same standard hourly rate regardless of fees or

awards that may otherwise apply. The clinicians need to work with the Service User

and staff directly involved in the support.

6.5.4 Occupational Health and Safety (OH&S)

A few Service Users may demonstrate occasional high risk behaviour or have other

episodic conditions. On these occasions where there is an OH&S issue, the Support


Provider may require additional staff to support them for a short period. Additional

support hours may be allocated for this purpose (See section 6.6 Support Plus).

6.5.5 Emergency Response

Each support package, single or shared, will have an emergency response

component of one hour per week calculated into the total hours. The full cost of the

hour should be ‘banked’.

An initial one-off allocation of $5,000 is also provided for this purpose. These funds

can also be banked and used flexibly over any or all of the Service Users to provide

essential support or an on-call response in the case of an emergency, or when

necessary.

6.6 Banked Hours

The weekly hours for each Service User’s TSP are set according to their assessed

needs/risks. However on occasions the hours may be used flexibly enabling a

reduction or expansion to a Service User’s support depending on the requirement

over the week or other time.

Unused hours may be banked for a specific Service User and used to pay for a

particular event or activity provided the Service User’s day to day support needs are

not compromised, placing the person, others or tenancy at risk.

Banked hours may be used as Community Integration Funds (up to $2,000 per

annum) to assist with the cost of education, memberships, accessing family or

relocating from one residence to another.

Funds that are not attached to a TSP are available for one-off expenses such as

training and development, equipment or household set up.

If not needed by one Service User, unused or banked hours may be used

periodically to expand the support requirement of another Service User. Any unused

hours at the end of each financial year will remain as ‘banked hours’ for the next

financial year.

If the value of the unused or banked hours accrues to more than $50,000 in a

financial year, the excess will be acquitted back to ADHC at the end of the financial

year.

6.7 Client Expenses

The funding attached to the TSP is solely for the provision of support for the Service

User (with exclusions stated above in banked hours).

In principle the Service User must pay for their personal expenses. It is assumed

that each Service User receives the Disability Support Pension or the like, or is in

paid employment. There are additional financial supports for which the Service User

may be eligible such as the Mobility Allowance and Rental Assistance.


Generally speaking, grant funds cannot be used for food, clothing, personal

household effects or rent. Only where there are short-term extenuating

circumstances should consideration be given to making an allowance for such items.

6.8 Annual Review of Support Package

On an annual basis, or as required each support package will be reviewed by the

Service Provider and the CJP Worker against the needs of the Service User.

Service Users, after a time, and when risk behaviours have decreased and life skills

increased, may step-down into a lower level and lower cost package funded from the

Pool or into a DIS.

An annual Support Plan with the support cost will be submitted to the Director, CJP

for approval. The revised TSP with the cost approval will be issued to the Service

Provider stating the banding level, annual funding allocation and service outputs for

the following year.

6.9 A Guide to Modelling a CJP TSP

Table 5 is a guide only and shows samples of the TSP costing and support allocation

based a specific number of assessed support hours, determined by their level of

functional support and risk.

The number of support hours per week is converted into an equivalent annual

funding amount and linked to annual service outputs. The annual funding attached to

each band is based on a unit cost per hour by the number of hours of support per

year. The annual service outputs are the total number of hours of support per year

for the package.

Table 5: Examples of CJP Tailored Support Packages as of January 2012

CJP TAILORED SUPPORT PACKAGE Level of Support

No. Direct Support Hours Per Week

Type of Costed Direct Support

Indirect Support TSP Annual Cost ( 2011-12)

Annual Outputs Support Hours

Moderate to

High with

High Risks

35 3 hours per day(21 hours

per week) living skills and

personal support

4 hours mentoring on

weekend

4 hours per week therapy

program

6 hours per week

vocational/educational

tutoring

Service Provider

At least 3 hours

support co-

ordination and

1 hour emergency

response per week

Informal

Informal support, 6

hours a week,

(footy training,

visits)

Informal support

12 hours sleep

over)

$ 80,000 1825


High with

High Risks

45 4 hours a day (28 hours


personal support (2 hours

am and pm)

6 hours mentoring (3x2

hour sessions)


program

5 hours per week


tutoring

2 hours lifestyle and fitness

training

Service Provider

At least 3 hours

support co-

ordination and

1 hour emergency

response per week

Informal

Informal support, 6

hours a week,

(footy training,

visits, outings)

Another person in

accommodation

2344 102,853

High with

Very High

Risks

55 5 hours per day (35 hours


personal support

(evenings)


weekend


program

5 hours per week


tutoring


training

Service Provider

at least 3 hours

support co-ordination

and

1 hour emergency

response per week)

Informal supports

Structured

environment/supervis

ed night time

arrangement

$122,000 2865

OVER-

COST

Complex

with Very

High Risks

70 8 hours per day (40 hours


personal support (mornings

and evenings)


weekend


program

15 hours per week


tutoring


training

Service Provider

at least 3 hours

support co-ordination

and

1 hour emergency

response per week)

Informal supports

Structured

environment/supervis

ed night time

arrangement

$160,000 3647

Notes: 1. Funding based on cost per hour rate: Attendant Care Program at $43.87 (Jan 2012).

6.10 Key Features of the TSP

The key features in managing a Tailored Support Package are that:

Whilst the support package or funds are notionally linked to a particular

Service User, it is not individualised funding, that is, the funds are not

attached to a specific Service User for a long term. Some TSPs are

recurrently allocated to NGO Service Providers and others remain

attached to the CJP Flexible TSP Pool.


The funds are received by a Service Provider that provides or brokers the

support service for the Service User.

The Service Provider can use the total package of support hours flexibly

in a week to support the Service User as needed. Hours are banked if not

used in one week, and may be used periodically to expand the support

required at another point in time if there is a behavioural episode, special

event, etc.

The CJP TSP Flexible Pool is transportable and can move to another

Service Provider in recognition that some Service Users may occasionally

move to another location in NSW but are not transferable interstate.

The TSP funding cannot be converted into a residential place.

The TSP support level and cost is reviewed annually and may be adjusted

to match the Service User’s assessment of risk and need.

There is provision for a Service User to live with a partner or their own

family. CJP funds, resources and support will be focussed on the Service

User.

Where the impact of family or community dynamics demonstrates a link to

offending/risk behaviour, consideration may be given to providing

resources/programs to the family or community to positively change the

situation.

7 ACCOMMODATION ARRANGEMENTS

7.1 Accommodation Options

There are various accommodation arrangements for a Service User who receives a

TSP. For the majority of young people receiving a support package the most likely

option is to return to their family and community of origin. Other options include:

ADHC owned unit, apartment, villa or town house;

Service Provider owned unit, apartment, villa or townhouse;

Hosing NSW/Community Housing managed unit, apartment, villa, town

house or cottage;

privately rented unit, apartment, villa or cottage; or

Service User’s partner/friend’s home.

The Service Provider will be required to establish links with accommodation

providers and advocate on behalf of the Service Users to gain appropriate housing

where a rental option is required.

7.2 Paying Rent


If the Service User is accommodated in an ADHC provided facility or other rental

property, they will be required to pay rent. The Service User may be eligible to

receive Rental Assistance and this should be sought.

The ADHC recurrent funding should not be used for this purpose and if there are

extenuating circumstances the Service provider may choose to waiver rental costs

and meet it from other sources or submit for one-off funds.

7.3 Residential Tenancy Agreements

Unless living in their own home, each Service User (or Guardian) renting

accommodation will be required to sign a Residential Tenancy Agreement.

Where there are Service Users sharing a residence, each may be required to have a

separate agreement (or licence).

There will be no head-leases with ADHC and preferably not with the Service

Provider unless the Service User’s accommodation history is such that they are not

able to do so and not doing so will jeopardise access to the accommodation.

7.4 Type of Accommodation

The accommodation should, where possible meet the following requirements. It

should:

provide each Service User with their own bedroom;

be located wherever possible in a residential neighbourhood, or in an area

zoned residential by the local government authority;

be in a locality where the risks associated with the Service User are

minimised;

have adequate space and facilities for the Service User;

have modifications made where the Service User has a functional or

physical need for improved access or safety;

have adequate provision for, or proximity to, outdoor recreation and

leisure space;

be in a reasonable state of repair and adequately maintained;

be safe and secure for the Service User and their possessions; and

conform to safety and fire standards as stipulated in the Building Code of

Australia and related regulatory conditions.

7.5 Specific Accommodation Requirements

If there are specific accommodation requirements for particular Service Users this

will be articulated in the Service User’s Support Requirements discussed during the

placement phase. Considerations may include:

community access: proximity to transport, shops, medical services,

employment/day program, family or recreational facilities;


physical access: ground floor accommodation, no gradients;

Service User safety: some fittings may need replacement e.g. safety

valves on taps; some locations may need to be avoided such as busy

roads, railway lines, waterways etc. and some building features may need

to be avoided such as stairs, pools or gas appliances; and

community safety: some locations may need to be avoided such as

schools, childcare centres, hotels etc.

7.6 Managing the Accommodation

The Service Provider will manage the accommodation needs of the Service Users.

They will also participate in regular communication with the housing provider:

regarding the Tenancy Agreements or in the case of ADHC the Deed of Licence.

Table 6: Accommodation Responsibilities and Activities of the Service Provider

Provider Responsibility

Specific Activity

Property Management Secure the most appropriate available property for Service Users.

Plan, monitor and ensure physical access and safety modification requirements are appropriate and in place.

Ensure responsive maintenance.

Tenancy Management Monitor the Residential Tenancy Agreement.

Mentor and assist Service User to adhere to the Agreement.

Collect rent.

Assist in maintaining harmonious neighbour relations and issue resolution.

It should be noted that some Service Users may have partners or families residing

with them in shared accommodation. All tenancy arrangements must be agreed with

and remain with the Service User unless the support is provided in the partner’s or

family’s residence.

7.7 Property Modifications

The CJP is primarily for people with an intellectual disability and for the most part

they are ambulant and active. However some Service Users may need changes to

the property prior to placement or over time. Some may have particular safety

considerations that will need to be addressed because of their behaviour or their

disability.

The types of property modifications may include:

installation of universal adaptive housing design features such as: the

provision of brighter and conveniently located internal and external

lighting, appropriate outside gradients and level surfaces, easy opening

door and cupboard handles, appropriately placed switches, etc.;


renovation of buildings to provide physical access to the property, by

widening doorways and internal spaces, and for improved kitchen, toilet or

bathroom access; and

installation of safety features such as safety valves on hot water taps, fire-

proofing, alarms, light timers, safety windows, railings, fencing, removal/

replacement of gas appliances.

Modifications need to be discussed, negotiated and undertaken by the property

owner. ADHC may be able to assist with costs associated with ADHC owned or long

term accommodation arrangements.

7.8 Set-up of Accommodation

In the initial budget for the TSP or subsequently at the time of the placement of a

Service User, funds may be available to assist with the initial accommodation set-up

including furniture, some appliances and household items. Those items purchased

should be listed on the Service Provider’s asset register and remain with the service,

a copy to be provided to the CJP. They are not the property of the Service User.

Over time, if there is a need for replacement of any furniture or goods a submission

to the Director CJP may be made.

Over the course of the placement, the Service Provider should encourage and assist

in the acquisition, budgeting and management of the Services User’s personal

goods.

8 SERVICE OUTCOMES

8.1 Service Outcomes

The TSP provider will ensure:

person –centred focus to deliver the level of support to manage risks

associated with reoffending, health and well-being;

stable tenancy and accommodation arrangements for semi-independent

living in rented accommodation or with family/others in a community

setting;

a focus on active support to develop social, communication and

citizenship skills to become a self-sustaining, participating and productive

community member;

mentoring to develop age and culturally support to conduct activities of

daily living and develop cultural and social connections; and

tutoring to develop independent living skills in order to achieve integration

into the community or use of less intensive services, delay entry to more

intensive services and reduce likelihood of a return to the criminal justice

system.

8.2 Service User Outcomes


The success of the TSP will be assessed against the extent to which Service Users

make a sustained transition from the criminal justice system into independent living

in the community, with limited or no support. Some of the outcome indicators of this

transition are listed in Table 7 below.

Table 7: TSP Service User’s Outcomes and Indicators

Service User Outcomes I Outcome Indicator

Service User has reduced or halted offending behaviour and has improved health and well-being.

has an IP Plan/Lifestyle in place and reaching

intended goals

has reduced criminal activity and ideation

shows discrimination toward negative activities in

their activities

reduced involvement with police, courts

reduced number of critical incidents

attends medical and dental treatment

attending/participating in therapy or clinical sessions

takes medication appropriately and regularly

shows a reduced or ceased drug and/or alcohol use

shows improvement in medical and or health

conditions and has a healthy diet

shows increased awareness of and participation in

healthy lifestyle pursuits, exercises, plays sport etc

The Service User has the skills to become a self-sustaining, participating and productive community member.

is able to manage money, banking and budgeting

is paying bills and expenses

is taking care of assets and own possession

has socially acceptable personal presentation and

hygiene

has consideration for others

has consideration for public property and amenities

is demonstrating socially acceptable behaviour

is engaged in employment or meaningful daily

activities

The Service User is able to make decisions and discern appropriately.

knows right actions and consequences

is self determining

shows consideration for self, friends and household

demonstrates restraint

gives reasons for actions

The Service User is able to sustain tenancy and live semi-independently and/or with others within a community setting.

is paying rent on time, understands and meets

tenancy obligations

cares for property, clothes and personal

possessions

shops, stores food and cooks


cleans and maintains hygienic environment

organises personal and household items

manages household chores

has harmonious neighbour relations

engages with family and others

The Service User has an interest in and is able to participate in appropriate activities and has developed social connections to appropriate others and supports.

is attending age appropriate venues, entertainment,

sports events

has a friendship group in place

has harmonious neighbour and family relations

has membership of organisations

is participating in and aware of cultural activities

The Service User has developed the skills for integration into the community or access to less intensive services, delay possible entry to a more intensive services or return to the criminal justice system.

travels safely and confidently on public transport

uses basic technology eg phone, appliances

meets obligations, complies with Parole/Court

requirements

shows a reduction in risk taking behaviours

requires reduced levels of support

has appropriate and long term accommodation

has a regular income ideally employed

attends TAFE/adult education

9 CJP TSP SUPPORT PROVIDERS

9.1 Service Providers

Providers of TSPs may be ADHC or a NGO. If a new service is to be acquired, NGO

Service Providers will be sourced through the pre-qualified list of accommodation

support providers and requested to submit a Service Proposal. Proposals are then

assessed after which the successful eligible provider is approved to deliver the

service and receive the recurrent funding.

9.2 General Requirements

A TSP Service Provider is required to be:

Capable of managing high risk and complex Service Users: by developing

positive and assertive case-management practices, providing appropriate

levels of structure and developing motivation and reward support programs to

change offending behaviours and life chances.

Able to provide highly skilled staff at all times: by providing training and

support to manage and supervise people with complex needs who may be

non-compliant.


Able to apply a positive and person-centred approach: when managing

and delivering support to people with complex needs and operating a flexible

and responsive service.

Able to operate a Restrictive Practices Authorisation: according to

professional standards.

Capable of service co-ordination and networking: able to liaise and

interact with other locally based service providers in order to:

seek appropriate specialist/clinical input when required;

ensure a seamless provision of support for the Service Users;

maximise responsiveness of services to the needs of individuals and

minimise barriers to person-centred service imposed by organisational

and administrative boundaries; and

monitoring the quality of outcomes and amount of service provided on

behalf of the Service Users where other services (professional, formal or

informal) are involved, and ensure that all responsibilities are met.

Able to engage with Guardians: for planning, monitoring and consent.

Accountable and viable: able to demonstrate financial viability and

accountability of the organisation over a continuous period.

Efficient and effective: able to demonstrate capacity to increase the flexibility

of service by:

building on existing resources, either within the organisation or the local

community;

extending the current capacity of the organisation;

providing contributions for the support of the proposed services;

including, revenue from other sources; or

using existing service management supports and the competencies of

staff involved in the direct service provision.

Capable of service management: able to demonstrate effective corporate

governance of organisational responsibilities including matters such as:

management and staff structures and meetings,

financial management;

industrial relations;

staff performance;

occupational health and safety and

measuring and monitoring the quality and quantity of service.

Compliant with the NSW Disability Inclusion Act 2014 and Disability

Service Standards: demonstrate that the organisation has policies and

procedures that deliver services in accordance with the Disability Service

Standards.


Compliant with contractual arrangements: demonstrate the organisation’s

compliance with ADHC’s Funding Agreement and other contractual

arrangements such as meeting the requirements of the Minimum Data Set

(MDS).

10 CONTRACTUAL ARRANGEMENTS AND MONITORING

10.1 Funding Agreement

All NGOs funded to operate a disability service are required to be party to the ADHC

Funding Agreement which has an attached Description of Service (DofS) which is a

summary of this Service Description.

This Agreement is entered into prior to the commencement of the service and relates

primarily to the requirements and conditions for the receipt of funds from ADHC. The

DofS describes the service to be provided and the performance outputs expected.

One of the Special Conditions attached to the Agreement is the Service Provider’s

compliance with the CJP Partnership Agreement.

Compliance with the Funding Agreement is monitored by the local FACS District in

line with the ADHC Quality and Safety Framework (QSF). All funded providers must

complete their current third party verification by 30 June 2015.

10.2 CJP Partnership Agreement

The CJP Partnership Agreement is entered into at the commencement of a new service

with the Service Provider outlines the way the Partnership will operate and includes:

Roles and responsibilities Dispute resolution

Monthly reporting requirements Communication protocol

Case conference schedules Program variation procedures

Training schedule ARMIDILO requirements

Security and emergency requirements Review Schedule

Individual Service User’s Support Requirements are negotiated and endorsed when

each Service User is placed.

Any variation to the Partnership Agreement must be requested in writing and will be

considered by the Director CJP and after approval of the Executive Director a new

Agreement may be issued.

10.3 Performance Indicators

Performance indicators measure those features of the TSP that demonstrate if the

service is operating effectively and efficiently. Performance indicators can measure

features at both the activity level and the service level.

According to the ADHC DofS, the performance indicators for an Intensive Residential

Support are:

1. Number of Service Users receiving a service

2. Average staff hours per week


3. Average expenditure per service

4. Average expenditure per Service User

5. Average expenditure per hour of service

6. Percentage of Service Users with current Individual/Lifestyle Plan

7. Number of new Service Users in the reporting period

8. Number of Service Users exiting in the reporting period

9. Number of vacancies in the reporting period

10. Number of Service User deaths in the reporting period

Also CJP requires:

11. Number of critical incidents in reporting period

12. Number of offences in reporting period

13. Number Service Users returning to a correctional centre in reporting

period

10.4 Minimum Data Set

CJP funding is under Stronger Together and subject to the National Disability

Agreement (NDA) data collection requirement. Services are required to provide

reports on service activities or outputs each quarter in the form of an electronic

return for the Minimum Data Set (MDS).

The CJP Tailored Support Packages is categorised as a 1.06 service type, (in-home

support) for this purpose.

__________________________________________________

CJP Contacts

The Community Justice Program is located at:

Ageing, Disability and Home Care

NSW Department of Family and Community Services

Level 4, 93 George Street

Parramatta NSW 2150

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