Greater Shepparton Vulnerability Guide Tool Kit
Training Session for MCH Nurses
Insert your municipality and date
Why are we here?
“In order to achieve improved outcomes for families
at risk, a paradigm shift is required, so that unequal
outcomes are seen as social injustices, rather than as
products of individual dysfunction or deficit.”
(Slee, 2006)
Training outcomes
Short term
 Development of a shared understanding between
MCH practitioners in relation to the parameters of
child and family vulnerability
 Practitioners understand the intent
of the Vulnerability Guide and feel
confident to use it.
Long term
 Use of the Guide contributes to increased
engagement of children and families who are
experiencing vulnerability within our MCH services.
Training content
Section 1: Introduction
Section 2: Understanding Vulnerability and
Protective Factors
Section 3: Using the Vulnerability Guide
Section 4: Evaluation and Forward Planning
Section 1: Introduction




Background information
Introducing the Vulnerability Guide
Value of the Vulnerability Guide
Components of the Vulnerability Guide Tool Kit
Background information
In 2011 Greater Shepparton was selected as one of the
two Enhanced Best Start sites in Victoria – the other
was Mildura.
A key indicator was ‘to increase the access and participation rates
of vulnerable children in MCH and Kinder services, particularly
those children known to ChildFirst and child protection’.
Background information
Four key activities
 Professional development Bridges out of Poverty Training
 Development of a Vulnerability Guide
 Place based actions/ activities to increase the
connection of vulnerable children and parents with
MCH and kinder i. e. MCH outreach home visiting
 A ‘Ready Services’ Audit
Background information
In 2011/12
 Research was undertaken in
relation to how vulnerability
was defined and what already
existed in relation to practice
‘tools’
 The initial Vulnerability Guide
was developed and
introduced.
Background information
In 2013/14
 The Vulnerability Guide format was
revised in response to feedback
received from the Greater
Shepparton MCH Team and
feedback from the 2014
Vulnerability Guide Workshops
 All resources related to the
introduction and use of the
Vulnerability Guide have been
collated into this web based Tool Kit
Introducing the Vulnerability Guide
The Child and Family Vulnerability Guide has been
designed, piloted and implemented with
extensive input from MCH management and
nurses in Greater Shepparton .
This training module has been developed so that
other municipalities can utilize the set of resources
developed at Greater Shepparton, to assist the
introduction and use of the Vulnerability Guide
within their own service
The Vulnerability Guide Elements
In developing the Vulnerability Guide, the following
areas were identified as the key aspects of reflecting
on the parameters and circumstances of child and
family vulnerability:
 Child safety, stability, development and wellbeing
 Parent/Caregiver capability
 Family composition and dynamics
 Family circumstances and economic environment
 Community factors.
Protective factors
Any consideration of vulnerability factors also
necessitates a reflection on the protective factors
which mitigate such vulnerability.
‘Every child and family will experience some
difficulties, and each will have some resources and
strengths to help through difficult times’
Kids Matter - Early Childhood Information Sheet No. 6 (www.kidsmatter.edu.au)
The Vulnerability Guide format
Designed to
be easy to use
Developed
by
practitioners,
for
Practitioners
with
practitioners
Five
vulnerability
categories
MCH Nurse
considers level of
vulnerability and
what response is
required
Value of the Vulnerability Guide
 Prompts nurses to consider a broad range of child
and parent vulnerability factors, and how these may
impact on child/family wellbeing
 Such consideration potentially results in a greater
level of responsiveness in support, counselling and
referral
 Child at risk icons on data base alerts other staff to
vulnerability issues
‘It is really useful – you know straight away that there
are factors that you need to be aware of’
Value of the Vulnerability Guide
 The Guide provides a common language framework
with which to discuss vulnerability issues and levels –
within and across services i.e with ChildFirst
 Improves data integrity
 Child at Risk Reports identify those children whose
needs are greatest and who should therefore be a
priority for regular monitoring and support
 Child at Risk Reports identify geographical
concentrations of vulnerability and inform staffing
decisions
‘It has been a very beneficial tool. It allows
quick identification of vulnerable families.
Particularly if you have not seen this family
before, the teddy alert allows a quick
prompt before starting the consult. It has
also allowed families to have more
support/follow up if they need it.’
Greater Shepparton Vulnerability Guide Evaluation November 2014
Intended Use - please note...
 It is only a guide - not a risk
assessment tool …
 It is designed to be - an alert, a
mechanism, a process, a reflection
tool
The Vulnerability Guide Tool Kit
Key components – they mirror this training …
Section 1 The Introduction outlines how the Vulnerability Guide Tool Kit
was developed, and describes the core elements of the Vulnerability Guide
and its key applications.
Section 2 Understanding Vulnerability and Protective Factors
An overview of what constitutes child and family vulnerability. What does
the current literature say? How does the Vulnerability Guide reflect this?
Section 3 Using the Guide in Practice Application of the Guide within
Maternal & Child Health Services.
Section 4 Monitoring and Evaluation Options for monitoring and
evaluating the use of the Vulnerability Guide
Section 2:
Understanding Vulnerability and
Protective Factors
Family Complexity
Early Brain Development
Cumulative Harm
Intervention
Life Outcomes
Vulnerability and Protective Factors
Factors which need to be taken into account
when considering vulnerability are wide
ranging and often complex
It is also important to consider protective
factors for children and/or their families when
reflecting on potential vulnerability in
child/family situations.
Vulnerability – Definitions
‘Children and young people are
vulnerable if the capacity of parents and
family to effectively care, protect and
provide for their long term development
and wellbeing is limited.’
Victoria’s Vulnerable Children – Our Shared Responsibility
Strategy 2013-2022
Vulnerability – Definitions
It is also seen as:
“situations in which a family’s needs cannot
be met from within their own resources or
their kith and kinship networks and where
services can make a valuable contribution to
child and family well-being.”
(Arney & Scott, 2011)
Vulnerability and Protective Factors
Protective factors have been defined as "a
correlate of resilience that may reflect preventive
or ameliorative influences: a positive moderator
of risk or adversity" (Masten & Wright, 1998).
Child or family vulnerability and its impacts can
“differ enormously depending on...disposition;
resilience; bio-psychological factors; family
environment and other supports; peers; security;
positive parent/child attachment; and previous
history.”
John Briere (2002) quoted in ‘Trauma Informed Care & Practice ‘(National Trauma-Informed Care & Practice
Advisory Group, Position Paper’ September 2013).
Vulnerability and Protective factors
Whiteboard/maxi sticky note activity:
What comes to mind when:
 You think about child vulnerability
 You think about protective factors
 You consider how you respond from a practice
perspective when working with families who have
identified vulnerabilities?
 Who supports you in your work
with vulnerable children and families?
Protective factors
Individual/child factors such as:
 good health
 positive peer relationships
 strong, positive social networks
 hobbies/interests
 high self-esteem
 independence
 secure attachment with parent/s
 social skills
 positive disposition.
Family/parental factors:
 secure attachment with child
 positive parent-child relationship
 supportive family environment
 extended family networks
 high level of parental education
 parental resilience
 concrete support for parents
 sound parental coping skills
 awareness of stages in child development.
Social/environmental factors:
 strong, positive social networks
 stable housing
 employment
 family expectations of pro-social behaviour
Read asavailable
is
 well-resourced schools
in
neighbourhood
 access to health and social services.
AIFS: https://www3.aifs.gov.au/cfca/publications/risk-and-protective-factors-child-abuse
and-neglect
Sources: Counts, Buffington, Chang-Rios, Rasmussen, & Preacher (2010); US Department of Health and
Human Services (2011).
Understanding Vulnerability
In understanding vulnerability there is a
very broad set of parameters to consider
 maternal factors
 other parenting/family factors
 baby health factors
 parenting capability
 potential environmental factors
 combination/s of these factors.
Understanding Vulnerability
The following are criteria for funded family support
services:
 single risk factors that need one off, short or long
term intervention.
 single risk factors that need an individualised
response
 multiple risk factors and long term chronic needs
 high risk of long term involvement in secondary
services
 cycles of disadvantage and poverty resulting in
chronic neglect and cumulative harm
Understanding Vulnerability
Doherty, Hall & Kinder(2003) looked at vulnerable
families in the following three groups:
 The underrepresented: groups that are marginalised,
economically disadvantaged or socially excluded
 The invisible or overlooked: families who may slip
through the net when service providers overlook or fail
to cater for their needs.
 The service-resistant: those who choose not to engage
with services, including those who may feel wary about
service involvement e.g. fear of children being removed.
Family Complexity
Families live under a diverse and complex set of
backgrounds and life circumstances which
encompass a broad range of factors
including:
 Culture
 Language
 Ethnicity
 Education
 Employment
 Social status, interactions or appearance.
Family Complexity
Added to these aspects are a wide range of social factors
which can increase the complexity of family circumstances
including:
 Family break up
 Parent or child with intellectual/cognitive
impairment or disability
 Lack of parenting skills - current or
intergenerational
 Poverty – current or intergenerational
 Unemployment - current or intergenerational
 Housing problems
 Drug and alcohol abuse
 Mental illness
 Family Violence.
Impacts on children
The potential impacts on children if these issues are
present can include:
 Emotionally unavailable parent/s
 Lack of/unhealthy attachment
 Extreme behavioural issues
 Abuse and neglect
 Family violence and exposure to trauma
 Developmental delay from environment and/or
drug related birth problems
 Chaotic life experience.
The factors highlighted in the previous slides
are reflected in the ‘indicative reasons’ of the
Vulnerability Guide
Vulnerability & Early Brain Development
 Brain development is characterized by ‘sequential
development and sensitivity’ and a capacity to organise
and change in a ‘use dependent’ way.
 Because brain development is sequential, disruptions
to normal development in early life will necessarily alter
later development of other areas of the brain.
 This suggests that the early life experiences of a child
have importance in the organisation of the mature
brain. (Perry 1997).
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian Government Department of Human Services
2007.
Early Brain Development and Intervention
Professor Jack Shonkoff writes:
“The same neuroplasticity that leaves emotional
regulation, behavioral adaptation, and executive
functioning skills vulnerable to early disruption by
stressful environments, also enables their successful
development through focused interventions during
sensitive periods in their maturation.
“The early childhood field should combine cognitive and
linguistic enrichment with greater attention to
preventing, reducing, or mitigating the consequences of
significant adversity on the developing brain.”
Shonkoff, J - Investing Early in Education (Education Forum 2011).
Vulnerability & Cumulative Harm
Cumulative harm is experienced by a child
as a result of a series or pattern of harmful
events and experiences that may be
historical, or ongoing, with the strong
possibility of the risk factors being
multiple, inter-related and co-existing over
critical developmental periods.
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian Government
Department of Human Services 2007.
Vulnerability & Cumulative Harm
With ongoing childhood trauma (cumulative
harm), ‘chronic stress sensitises neural pathways
and over-develops certain regions of the brain
involved in anxiety and fear responses.
Meanwhile, other neural pathways and brain
regions are under-developed.’
Cumulative Harm: a Conceptual overview. Best Interest Series, Victorian
Government Department of Human Services 2007.
Vulnerability and life outcomes
Recent research suggests that two out of three patients
presenting at emergency, inpatient or outpatient mental
health services have underlying complex trauma
secondary to childhood physical or sexual abuse.
If emotional abuse, chronic neglect and the impacts of
witnessing domestic violence or growing up with
significant family violence, substance abuse and poverty
are also included, the percentage is even higher.
The single most significant predictor that an individual
will end up in the mental health system is a history of
childhood trauma.
*Trauma Informed Care & Practice (National Trauma-Informed Care & Practice Advisory Group, Position Paper,
September 2013).
We now look at how all this theory and research
impacts on our daily practice in MCH ….
Vulnerability factors and parent engagement
Sample AEDC Results
(insert your current
AEDC results below )
Family Engaged
Child developmentally
‘on track’
Family Engaged
Child developmentally at risk
or developmentally
vulnerable
Family
Not
Engaged
Developmentally
On Track 72.1%
Child
‘on track’
Family
Not Engaged
Child
developmentally
at risk or
developmentally
vulnerable
Developmentally
At Risk 16.5%
(Vul on 1 or more domains)
Developmentally
Vulnerable 11.4%
(Vul on 2 or more domains)
How do we define engagement?
Engagement in practice...
‘The relationship between service providers and service users is a
major factor influencing the engagement of parents in mainstream
services’
‘The service system needs to…increase its collective capacity to
respond promptly to the needs of vulnerable families by:
 building stronger links between services
 developing a systematic outreach capacity to reach isolated and
transient families
 providing a range of ‘soft’ entry points to the service system to
suit the needs of vulnerable families.’
CCCH Policy Brief No 18 2010: Engaging Marginalised and Vulnerable Families 2.
Vulnerability factors and parent engagement
Activity:
1. Think about some of the families you work with
and picture a family that fits into each of the categories:
 Family engaged and child developmentally ‘on track’
 Family not engaged and child developmentally ‘on track’
 Family engaged and child developmentally at risk or
developmentally vulnerable
 Family not engaged and child developmentally at risk or
developmentally vulnerable
2. Discuss how your practice is different according to the varying
levels of engagement and vulnerability.
3. Record some key ideas and feed back to large group discussion.
Section 3
Using the Vulnerability Guide
Getting Started
Practice Scenarios
Progressive Universalism
Data Audit
Getting started – our process
Add your details here in relation to actions
undertaken (actual or intended) to prepare for the
introduction of the Vulnerability Guide.


Familiarise ourselves with the Vulnerability Guide
Possibly up of data categories in client data base ‘alert’
fields to correspond with Vulnerability Guide ‘categories’
and ‘indicative reasons’
 Preparation of materials i.e. laminate 2 sided
Vulnerability Guide for each Centre
• Possibly print a copy of the Vulnerability Guide Tool Kit
for each Nurse – or particular pages
 Undertake a data audit
Use of the Vulnerability Guide
ACTIVITY:
MCH Scenarios - working in pairs or small groups:
With reference to the Vulnerability Guide and using
the Practice Scenarios
What do you think are the key indicative reasons
and the subsequent primary vulnerability category
for this child/children
 What level of vulnerability would you think is
appropriate to denote in the client record?
 Feedback to larger group
Activity
Familiarize Nurses with the relevant sections of
the Vulnerability Guide Tool Kit - how the level
of vulnerability and indicative reasons are
recorded in the MCH client data system.
Progressive Universalism and the
Vulnerability Guide
MCH – working across the spectrum of
vulnerability
How do you think the use of the Vulnerability Guide
would assist us to identify and document the
vulnerability and protective factors which influence this
continuum?
In what ways would it be useful
when a MCH Nurse is working
collaboratively with other services
to provide ‘integrated support’ for
a child and their family experiencing vulnerability?
MCH – working across the spectrum of
vulnerability
Activity
Let’s think for a moment about how our MCH Service
works across this continuum of vulnerability.
 Our schedule of visits
 Provision of outreach and additional visits/contact
 How we use our Enhanced MCH resources
 How we work with other agencies to provide
integrated support to families
Now for the …… Data Audit 
 This is a great way to
improve data accuracy
Customise your own words
from here re your process
 We will be undertaking a
data audit and have
prepared a guide for this
Now for the …… Data Audit 
 We will use our Child At Risk Reports to assist us to
see which children require a review of
vulnerability risk/status
 Determining the vulnerability status of children on
our system with an ‘alert’ designated, whom we
have not been able to contact for more than 2
years. We will be liaising with ### (ChildFirst)
agency to develop an interagency protocol to
assist with this.
Now for the …… Data Audit 
Activity
 Walk through data audit process
 Consider any priorities
 Consider Child at Risk/other system reports which
denote alert listings.
Section 4
Evaluation and Forward Planning
Evaluation methods
The Next Steps
Monitoring and Evaluation
Examples
 The evaluation feedback from Vulnerability Guide
workshop sessions
 Xpedite/MaCHS Children At Risk Reports - used
to monitor progress of data audit
 Other data reports that list types of vulnerability
identified
 Practitioner surveys such as Survey Monkey to
evaluate effectiveness of the Vulnerability Guide.
 Reflection at Team Meetings
Monitoring and Evaluation
 Xpedite/MaCHs Children At Risk Reports - used to
prioritise family contact/follow up and monitor
progress of data audit Insert sample data.
No. of children currently at risk August 2014
70
60
50
Baker St
Truror
40
Capital Ave
30
Levesely
Dartly Cres
20
Wanganelli
10
0
Baker St
Truror
Capital Ave
Levesely
Dartly Cres
Wanganelli
Monitoring & Evaluation
Monitoring and Evaluation
Suggested Activity: Xpedite/MaCHs
Nurses to look at their individual centre Children
At Risk Reports. Raise and discuss any issues in
relation to Data Audit.
Team Leader to prepare contrasting examples of
levels of vulnerability per centre – discuss.
The Next Steps….
Add your steps here
 Development of an implementation plan with
timelines and designated responsibilities.
 Implement and use the Vulnerability Guide
Tool Kit within our team
 Ensuring that the Vulnerability Guide is used
consistently as part of ongoing individual and
team practice with children and families by
…….(add actions)