Skills for Implementing New Practices in Child Welfare Settings September 16, 2020 Annual Conference Public Children Services Association of Ohio
(US Department of Justice/OH Attorney General 2019-VOCA-132234677) (S4A 76434) (Bunger) Acknowledgements (R34DA046913) (Bunger)
Learning Objectives 1 2 3 Increase participant’s Increase participants’ Provide participants knowledge of the readiness for leading with implementation stages of implementation planning resources implementation initiatives in their (EPIS framework) agencies.
Today’s Agenda 1. Introductions 2. Intro to Implementation 3. Exploration 4. Preparation 5. Implementation 6. Sustainment 7. Wrap Up
WELCOME! 1. Intro’s • Put your name, agency, and role in the chat
WELCOME! 1. Intro’s • Put your name, agency, and role in the chat
2. Intro to What is Implementation? Implementation
• Active and planned efforts to What is mainstream an innovation within Implementation? an organization (Greenhalgh, et al 2004)
The Implementation Research Framework Intervention Implementation Strategies Outcomes The evidence- Deliberate efforts based prevention to integrate an Implementation Service Delivery Client or treatment EBI into routine e.g. fidelity, e.g. efficiency, e.g. safety, intervention to be practice settings acceptability, timeliness, permanency, implemented feasibility satisfaction well-being … how you are The thing you are implementing implementing… Proctor et al., (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges.
Implementation Strategies Powell, B. J., et al. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Planning Educate Finance Restructure Quality Policy Management • Assess needs • Develop & • Provide incentives • Revise roles • Change distribute accreditation • Assess readiness • Use capitated • Create a team • Develop fidelity materials standards and barriers payments • Change site monitoring system • Ongoing training • Change liability • Visit other sites • Penalize • Equipment • Audit and laws • Train the trainer • Develop a plan • Place on fee-for- feedback • Change records • Create licensure • Consultation service list • Tailor strategies to system • Reminders or credentialing address barriers • Learning • Access new • Provide technical standards Collaborative funding • Build-buy in assistance • Engage local • Make billing easier • Engage families • Provide clinical opinion leaders supervision • Recruit leaders • Educate families • Ongoing team • Issue mandates • Work with meetings • Build a coalition universities • PDSA cycles • Contracts and partnerships
What strategies should you use in your agency? When? How Much? What information should inform your plan?
GWC Implementation Strategies - Total Hours 200 Active Implementation Pre-Implementation 180 160 140 Bunger, AC, et al (2017) Tracking Implementation Strategies Prospectively: Description of A Practical Approach and Early Findings. 120 100 80 60 40 *Provider *Launch* Transition* 20 0 May June Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June July 2014 2015 2016 Policy QM Restructure Finance Ed Planning
https://episframework.com 2
Moullin, J.C., et al. Systematic review of the Each phase is influenced by Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Sci 14, 1 (2019). factors at multiple levels
• Developed to understand implementation in PUBLIC systems • Emphasizes collaboration with partners • Encourages us to be rigorous in our planning AND pragmatic • Approaches implementation as an iterative and dynamic process • Begins with sustainment in mind
Step 1: Exploration Evaluate need and fit of an EBP **Adoption decision driven by data and information
Step 1: Exploration What does our community need? What are the most effective models? How well do they fit our context?
Step 1: Exploration • Form an implementation team/steering What does our committee community need? • Conduct a needs assessment TIP! - Use SACWIS, charts & other existing data What are the - Draw on local reports most effective - Referrals to external providers - Focus groups w/caseworkers, kids, families models? - Gather feedback from other sites - Engage coalition/collaboratives How well do *****In the CHAT***** What data sources have you used to understand needs they fit our in your community? (or… what data would you LIKE to context? have?)
Step 1: Exploration Child Welfare-Related EBP Registries: • Title IV-E: https://preventionservices.abtsites.com/ • CEBC4CW: https://www.cebc4cw.org/ • Form an implementation team/steering What does our committee community need? • Conduct a needs assessment • Identify models/practices How effective are they? What are the • Do they address your target outcome? • most effective models? *****In the CHAT***** What data sources have you used to understand needs in your community? (or… what data would you LIKE to How well do have?) they fit our context? Walsh, C., Rolls Reutz, J., & Williams, R. (2015). Selecting and implementing evidence-based practices: A guide for child and family serving systems [2nd ed.]
Step 1: Exploration • Form an implementation team/steering What does our committee community need? • Conduct a needs assessment What are the • Identify models/practices most effective How effective are they? • models? Do they address your target outcome? • • Decide with your team, committee, or group How well do they fit our context?
Step 1: Exploration How well does it fit with our families? - Support from consumer groups? - Effective for different demographic groups? What does our - Addresses the community Families need? What are the ADOPT! most effective models? Organization System How well does it fit with our agency?: How well does it fit with system? How well do - Values? - Is it consistent with our - Culture/Climate? policy/legislative requirements? they fit our - Capacities? - Can we fund it now? In the - Leadership support? future? context? - Knowledge/skills? - Leadership support?
Step 1: Exploration Case Example
Step 1: Exploration Resources ● California Evidence-Based Clearinghouse for Child Welfare (CEBC4CW) ○ Exploration Worksheet ○ EBP Selection Worksheet ● Community Toolbox ○ Help Taking Action Troubleshooting Guide: We need to understand the community or situation better
Develop your implementation plan Anticipate major challenges • Identify strategies to promote • Adapt EBP if needed Step 2. • Preparation Engage Stakeholders 2 Train your staff
Step 2: Preparation Develop Your Implementation Plan How will you fund services? • Medicaid? Child welfare funding? Foundation grant? Research grant? What resources are needed? • Space? Equipment? IT support? Buy-in from staff and Collaborative partners? Who will deliver services? • Who will staff the program? Supervise? Provide support? Do you have to hire? • Self-referrals? From caseworkers? External providers? What is the process? How will you generate referrals? Eligibility criteria? Materials needed? • One-time training? Boosters/reminders? Expert or developer led? Train the How will you train/support staff? trainer? Consultation or TA? Training for leaders? • Established measure or new one needed? Data collection procedures? How How will you assess fidelity? will you report back? How often? Do you need to adapt? • What would you adapt? Why? Will it compromise core components? How do you build a supportive • Who's buy-in do you need? How will you reward and support? climate?
Step 2: Preparation POLL – What are the top 3 challenges to implementing in your agency? Inner Setting (Organization) Outer Setting (System) Agency size Federal or state legislation Implementation Hierarchy Local resources and programming Caseloads Funding is HARD Leadership Client advocacy (major lawsuits) Role specialization Partnerships with other organizations Strategize around Values Information major challenges Caseworker Knowledge/skills Values/Expectations of Judges Supervisor capacity Data systems
Step 2: Preparation Case Example
Step 2: Preparation Resources ● QIC for Adoption & Guardianship Support & Preservation ○ Teaming Structure & Charter ● Sample Implementation Plan ● The Fidelity, Adaptation, Sustainability, and Training (F.A.S.T.) Lab ○ Framework for Reporting Adaptations & Modifications (FRAME)
GO! • Continuous assessment Step 3. • Adjust strategies Implementation **Emphasis on quality management and reaching fidelity
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