NATIONAL SCALE: EXPLORING THE KEY ELEMENTS OF IMPLEMENTATION OF THE - - PowerPoint PPT Presentation

TAKING AN EVIDENCE BASED MODEL TO A NATIONAL SCALE: EXPLORING THE KEY ELEMENTS OF IMPLEMENTATION OF THE CARE MODEL Dr Belinda Mayfield, Practice Partner Life Without Barriers

• Why a Model?
• Why the CARE Model
• Overview of CARE and Therapeutic Crisis

Intervention (TCI)

• Key elements of implementation
• Benefits and challenges of going to scale
• Examples of baseline data

OVERVIEW

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TO HELP US CHANGE THE WAY WE DO THINGS

• Remaining engaged with research

developments and the evidence base to find better ways of doing things

• Supporting the growth of evidence-

based practice and programs

LEARNING CULTURE

• Supporting our staff to engage with

the ‘why’ behind what we do, and encouraging innovation.

• Making sure our people are

equipped to be their best

Ensuring our services have a program logic, outcome measures and the time and space to evaluate them

RESEARCH, EVALUATION & CONTINUOUS IMPROVEMENT

Knowing what we want to achieve and how this changes lives for the better so we can plan how to get there

FOCUS ON OUTCOMES

EVIDENCE

WHY EVIDENCE?

Professional Decisions

Theoretical Knowledge Empirical Knowledge Procedural Knowledge Practice Knowledge Personal Knowledge

Ref: Drury-Hudson, 1997

WHY A MODEL?

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• Our purpose is to partner with people to

change lives for the better; fundamental

• bligation to always try to do the best for
• ur clients
• We want to close the gap between what

we know works best and what is done every day

• We know that using evidence to guide
• ur service delivery can improve
• utcomes for the people with whom we

partner

• A model synthesises research, theory

and practice knowledge

• Advantages of shared understanding;

shared language

WHY A MODEL?

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• Fit’ with LWB values
• Level of available research evidence
• Only model with explicit theory of change
• Builds on our existing use of TCI
• Accessibility
• Contributes to growing the research

The California Evidence-Based Clearinghouse for Child Welfare has rated the CARE model as promising research evidence and highly relevant to child welfare practice.

WHY CARE?

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A principle-based practice model designed to guide staff and carers practice and interactions with children in order to create the conditions for change in children's lives. Core Concepts

• Best Interests of the Child
• Struggle for Congruence
• Evidence Informed Program Model

CARE IS:

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• Relationship based
• Developmentally focused
• Family involved
• Competence centered
• Trauma informed
• Ecologically oriented

CARE PRINCIPLES

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• A trauma informed crisis prevention and

intervention model

• Designed to teach staff how to help children and

young people learn constructive ways to handle crisis and to regulate stressful feelings of hurt / frustration / anger

• The TCI System involves leadership, clinical

participation, training and competency standards, supervision and incident review, and documentation and monitoring THERAPEUTIC CRISIS INTERVENTION (TCI)

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• 4 year implementation agreement with Cornell (CARE + TCI)

– National CARE implementation team (1 dedicated project officer) – Communication strategy

• Training & technical assistance (approx. 3 on-site visits per year)

– 2 day leadership retreat (state level) – 4 day leadership workshop (state level) – 5 day CARE education + 3 day TCI = all staff

• Strategies to embed and sustain application of the principles (advanced

workshops; supervision and reflective practice)

• Review of current systems, procedures and documentation
• Quality assurance activities
• Data-informed decision making

KEY ELEMENTS OF IMPLEMENTATION

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FOSTER CARERS 739 OOHC STAFF 328 OOHC CLIENTS 1,925 FOSTER CARERS 8 OOHC STAFF 66 OOHC CLIENTS 26 FOSTER CARERS 1,309 OOHC STAFF 479 OOHC CLIENTS 1,458 FOSTER CARERS 184 OOHC STAFF 85 OOHC CLIENTS 251 FOSTER CARERS 277 OOHC STAFF 109 OOHC CLIENTS 134 FOSTER CARERS 58 OOHC STAFF 39 OOHC CLIENTS 139 FOSTER CARERS 107 OOHC STAFF 92 OOHC CLIENTS 172

Size and Scale: 1198 staff Dispersed across 100s

• f

locations

• Organisational Social Context surveys
• CARE Knowledge and Beliefs Baseline Surveys
• Youth Perceptions Surveys
• Post Training Surveys
• Available agency data indicators, including:

–Incidents –Staff retention –Use of agency staff

SOURCES OF DATA

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CARE Baseline Report

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CARE Survey Report Youth Perceptions Survey (YPS)

Selected Results from Baseline Data/September 2016 Data Life Without Barriers

CARE KBS Report for LWB-All 10/6/2016

YPS Sample Item for Listening & Understanding September 2016 Survey N = 30

CARE YPS Report for LWB-NSW 10/13/2016

Needed Help: “They tried to understand what I wanted.”

6.7% 13.3% 23.3% 26.7% 30.0% 0% 20% 40% 60% 80% 100% Never 1 Rarely 2 Sometimes 3 Usually 4 Always 5 Percent of Youth Average = 3.6 20.0% 23.3% 56.7% Never/Rarely Sometimes Usually/Always

Incidents Attachment 3.1 3.2 3.3 3.4 3.5 1 3 5 7 9 Baseline 12 mo 24 mo 36 mo Youth Relationship Quality Overall Score Incidents per 1,000 Care Days

INCIDENTS AND RELATIONSHIP QUALITY

Before CARE CARE Training & TA

• Izzo, Smith, et al.

Behavioral incidents declined during CARE

INTERRUPTED TIME SERIES STUDY

(IN PRESS)

• Izzo, Smith, Holden, et al.

Prevention Science (2016)

Post Training Survey Report

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CARE Post-Training Report

• Already seeing observable changes eg the physical

environments of the residentials; family involvement; intentional, reflective practice

• The logistics of taking frontline staff off line for training (size &

scale); resistance to change; staff turnover

• Importance of communication/messaging across all levels of the
• rganisation
• Readiness/ variations in service maturity across sites and teams
• Shifting from a reactive to data driven organisational culture
• Leadership investment at all levels of the organisation
• Shared language across the organisation

REFLECTIONS: STRENGTHS AND CHALLENGES:

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22 CARE Post-Training Report

When you plant lettuce and it doesn’t grow well, you don’t blame the lettuce. —Thich Nhat Hahn, Vietnamese Buddist Monk

THE ECOLOGY OF A SUPPORTIVE ENVIRONMENT

Any questions/ like to know more…… belinda.mayfield@lwb.org.au veronica.marin@lwb.org.au

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