The Evidence Portal

Family driven goal setting and planning

Flexible activity

In this activity, families work with case managers to identify and set goals for themselves. This ensures the family’s needs and goals are at the centre of service delivery.

Goal setting and planning can support families to:

  • identify and reinforce their strengths
  • build problem-solving skills
  • strengthen family support networks
  • help parents identify and address other risk factors (e.g. substance use)
  • identify other services that are necessary to support the family

Developing a plan to support the family can ensure they are provided with multiple and integrated supports for all family members.

How can it be implemented?

This activity is typically conducted in existing home visits. Case managers work with families to develop a support/service plan. This process involves:

  • Conducting an assessment of the family’s needs
  • Identifying shared goals the family wants to achieve
  • Planning how to achieve those goals
  • Identifying how to monitor progress towards achieving the goals
  • Encouraging families to be active participants in achieving their goals
  • Reviewing the plan and assessing progress
  • Adjusting the plan as needed

Home visits typically run weekly, for 45 minutes to 2 hours.  The frequency and length of sessions may reduce as family’s needs lessen. Home visitation can last for 4-12 months. The length of the program should be based on client needs. Sessions can be conducted with all relevant family members (e.g. parents, grandparents, siblings etc.).

Where relevant, other practitioners can be involved in developing the plan. For example, a teacher, disability support worker or a mental health practitioner. 

Planning and goal setting may also be achieved via family group decision making conferences (FGDM). FGDM is a family-centered process where family members lead decision-making in addressing concerns related to child safety and wellbeing while being supported by caseworkers and service providers. 

Embedded throughout the program or have specific sessions for goal planning.

What should I consider when working with Aboriginal people and communities?

  • Case management with Aboriginal and Torres Strait Islander families should be undertaken by Aboriginal practitioners where possible, or Aboriginal practitioners should be engaged and valued to provide information about community, cultural protocols and world views.
  • Be aware and respectful of relevant extended family and kinship structures when working with Aboriginal people. Ensure that extended family is included in important meetings and in making important decisions (DCJ Practice Resource: Working with Aboriginal People).
  • See the Cultural Safety and Wellbeing Evidence Review for more information.

Who is the target group?

This flexible activity has been implemented with a number of target groups. Key characteristics include:

  • Families with children 12 years and under deemed at a high risk of abuse or neglect
  • Families with children aged 10 years and younger and have been deemed high-risk for child maltreatment.
  • Families with two or more risk factors associated with child maltreatment and/or parenting struggles.
  • Parents who were on methadone maintenance and had children aged between 2 and 8 years
  • Parents who have children under the age of 4 and are considered at risk for child abuse and neglect
  • Families in neighbourhoods with extreme poverty, unemployment and general economic distress

What programs conduct this activity?

  • In the Child FIRST program, a family driven plan of broad, integrated supports and services for all family members is developed. This plan reflects family priorities, strengths, culture, and needs.  
  • In the Family Connections program, outcome driven service plans are developed based on the specific risk factors of a child, parent, family or environment. Home visits are then tailored to the specific needs of the family. 
  • In the Hawaii Healthy Start program, home visitors work with families to set and reach family goals.
  • In the Healthy Families America program, families develop individual family support plans (IFSP) that establish specific goals and identify the families’ strengths.  The IFSP is a plan between the family and the home visitor that helps set achievable goals to alleviate family stress and to enhance aspects of parental and family functioning.
  • In the Parent Aide Services and Case Management program a parent aide visits families up to two times a week. Their work is structured by setting up goal plans with families, and reviewing these quarterly.  
  • In the Parent Support Outreach Program, a service plan is developed with the family that structures case management activities and sets the goals for the case.  Families are encouraged to make decisions about their needs and possible solutions, and to be active participants in their service plans. Family Group Decision Making (FGDM) conferences are employed frequently as part of the Parent Support Outreach Program. 
  • The Parents Under Pressure Program begins with a comprehensive assessment and individual case formulation conducted collaboratively with the family. Shared goals and ways to monitor progress on these goals are identified. 
  • In the Relief Nursery Prevention Program teachers, specialists, and parents work together to establish individual goals for each child in the program.

Further resources


Last updated:

25 Nov 2022

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We acknowledge Aboriginal people as the First Nations Peoples of NSW and pay our respects to Elders past, present, and future. 

Informed by lessons of the past, Department of Communities and Justice is improving how we work with Aboriginal people and communities. We listen and learn from the knowledge, strength and resilience of Stolen Generations Survivors, Aboriginal Elders and Aboriginal communities.

You can access our apology to the Stolen Generations.

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