Greg Antcliff, Professional Practice, The Benevolent Society - Reaching involuntary or hard-to-reach parents


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Greg Antcliff, Director, Professional Practice, The Benevolent Society delivered the "Reaching involuntary or hard-to-reach parents" presentation at the Child Protection Forum 2013. He spoke about practice frameworks and intervention best-practice.

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Greg Antcliff, Professional Practice, The Benevolent Society - Reaching involuntary or hard-to-reach parents

  1. 1. Developing a evidence-informed practice framework for hard to reach families : A Resilience Practice Framework GregAntcliff DirectorProfessionalPractice TheBenevolentSociety,Australia InauguralAustralianChildProtectionForum: SydneyHarbourMarriott 10-11th October2012
  2. 2. Overview •The Why ? : The need for an organisational approach to practice •The What ?: Developing an evidence-informed Resilience Practice Framework practice framework •The How ? : What core components of Implementation ( competency, leadership, organisational ) act as barriers and facilitators to effective implementation of the Resilience Practice Framework ? 2
  3. 3. Phase One : The Why ? 3
  4. 4. The need for an organizational approach to our work
  5. 5. 5 What is Evidence Informed Practice? Adapted from What Works for Children? Evidence Guide. Economic & Social research Council et al 2003 Evidence-informed practice is the use of best evidence combined with the knowledge and experience of practitioners, the views and experiences of service users and the context in which it is to be delivered.
  6. 6. The What ? : Resilience Practice Framework and developing the evidence informed practices 6
  7. 7. 8 Scale of the Implementation Who does it involve : •350 Child and Family staff •5 large geographic areas ( 60 sites in two states in Metropolitan, Regional & Rural contexts) Across program types : •Early intervention& prevention •Integrated Early Years Centres •Child protection •Out-of-Home Care
  8. 8. What have we done so far ? •Exploration and adoption : Senior Management agreed to adopt Resilience as the overarching Practice Framework across TBS child and family services late 2009 Phase 1 - Implementation plan 2010 – 2011 •Design and deliver training to over 350 TBS staff ( 2 days) •Literature reviews for each domains of Resilience (ACCP), Community Resilience and Resilience in older people •Hosted a Master class with Prof. Robbie Gilligan ( Resilience expert) •Learning circles ( 6 sessions at 6 weekly intervals) •Resilience TV - 6 episodes 9
  9. 9. Phase 1 : Implementation 2010-2011 cont.. •Developed Practice Guides on complex topics - Cumulative harm; Infants at risk of abuse and neglect) – Australian Institute of Family Studies ( Co-production of knowledge) •Documented the Resilience Practice Framework •Resilience newsletter showcasing staff’s application of the framework. •All staff event around the concept of Resilience •Evaluation of training and the learning circles : staff were implementing the concepts of resilience into daily work but needed more support to embed it into practice. 10
  10. 10. Evaluation of Learning and Development Resilience training survey 0 0.5 1 1.5 2 2.5 3 3.5 4 TBS Resilience practice framework, rationale & research Naming the 3 building blocks of Resilience. naming the 6 domains of Resilience. describing 3 questions to assess strength and need in each Resilience domain. using coaching methodology effectively with children and families. utilising the TBS resilience tools. a resilience approach to inform and improve your practice. Level of confidence about... Rating1-4 Before training After training NotconfidentVeryconfident
  11. 11. Voice survey Area Weather Map 2012 Q136 – I am applying the Resilience Practice Framework to my day to day work with clients ? 12 Whole Society 80% Macarthur Region 85% Bankstown, Liverpool, Fairfield 85% Comm. Care Nepean 95% Central Coast Hunter 81% New England 90% Central West 87% Brisbane & SE Qld 81% Central & FN Qld 72% Finance, Hr, IT, Comms, OPIS, Corporate Exec. 67%
  12. 12. End of Phase 1 •High levels of satisfaction with the initial training •Staff are using the language of resilience across diverse programs (Child Protection, Early intervention, OOHC, Family Support) •Shared Framework identity gaining momentum •People using Resilience Practice Framework (RFP) more explicitly than before •Great start but the hard work of embedding and sustaining is about to begin  “I must of wasted so much time on home visits before having the Resilience Practice Framework. My clients are probably clearer about why we are doing what we are doing” “The Learning Circles have been a great place for us to learn from each other across teams. There have been many light bulb moments from sharing practice wisdom”. 13
  13. 13. 14
  14. 14. Co-Production of Knowledge 15
  15. 15. Development and adoption The 4 phases of development and adoption include: 1. Clarify desired aims and outcomes of the project or service. 2. Collect and summarise the evidence base and map practice. 3. Select and adapt knowledge to local context. 4. Select, tailor and/or design program or practice framework.
  16. 16. Resilience definition & child outcomes Definition of Resilience “Strength in the face of adversity. The capacity to adapt and rebound from stressful life events, strengthened and more resourceful” Child outcomes of a resilience –led approach : •Secure and dependable relationships •Increasing self efficacy •Improving safety •Improving empathy •Improving self regulation / coping skills 17
  17. 17. Evidence-based practice and programs Practices •Skills, techniques, and strategies that can be used by a practitioner. •Common elements (Chorpita et al / kernals ( Embry, 2004) Programs •Collections of practices that are done within known parameters ( philosophy, values, service delivery structure, and treatment components)
  18. 18. Evidence-based practice and programs Programs •Collections of practices that are done within known parameters (philosophy, values, service delivery structure, and treatment components) Practices •Skills, techniques, and strategies that can be used by a practitioner. •Common elements or practice components/kernals(Chorpita et al; ( Embry, 2004)
  19. 19. Common elements and practice Not programs • ‘Kernels’ or ‘Active ingredients’ (Embry & Biglan, 2008) • Common Elements (Chorpita et al., 2005) • Identification and integration of the essential components of effective, manualised interventions • “a discrete clinical technique or strategy (e.g. ‘time‐out’) used as part of a larger intervention plan” • Common elements can be identified, specified and implemented according to the unique service context
  20. 20. Why common elements ? • Broader focus and application, particularly for frontline workers who report finding that prescribed programs simply do not fit the individual families' own unique context. • Other problems: time limitations in having to ‘wade through’ the evidence in order to select interventions using the evidence base as a guide. • Identifies key factors that work for vulnerable families • Identified factors and general principles that characterise ‘what works’ to improve outcomes
  21. 21. How common elements/kernals are indentified ? How common elements/kernels are identified ‘Gold Standard’ programs in research evidence selected. Where evidence showed a high degree of effective change and positive outcomes, program set aside aside. • Distillation process to identify commonalities of treatment components within each treatment program. • Once treatment components identified, ‘distilled’ and logged in a database (See PracticeWise DataBase)
  22. 22. Phase three : The How ? 26
  23. 23. Evidence Informed Practice (EIP) •EIP is the expected approach to improving the quality of practice and service delivery •For many reasons, best evidence is not being taken up in practice settings, and many children and their families are not receiving the best possible programs and support •Many programs and practices found to be effective in child and family support fail to translate into meaningful outcomes across different service settings 27
  24. 24. 28Adapted from Riley, 2005 World of Research World of Practice Implementing Evidence-Informed Practice Implementation
  25. 25. Science to Service Gap •Often what is known is not what is adopted to help children, families and caregivers Implementation Gap •There are no clear pathways to implementation. •Often, what is adopted is not used with fidelity and good effect •What is implemented often disappears with time and staff turnover
  26. 26. Critical barriers to EIP •Organisational setting or context •The capacity of the workforce to implement EIP •Addressing organisational polices and processes •Narrow project, practice standards, guidelines, or procedure-orientated approach to introducing evidence (Johnson & Austin, 2006) 30
  27. 27. Implementation Science Implementation occurs in stages: • Exploration & Adoption • Installation • Initial Implementation • Full Implementation • Innovation • Sustainability Fixsen, Naoom, Blase, Friedman, & Wallace, 2005 31 2 - 4 Years
  28. 28. Implementation Drivers 32 Implementation Drivers
  29. 29. Applying the Quality Implementation Framework (QIF) The Implementation framework to guide this implementation is the phases and critical steps identified in a recent synthesis of implementation frameworks completed by Meyers, Durlak, & Wandersman ( In press) •Synthesis of 25 implementation frameworks reviewed •Four major findings to guide quality implementation 1. 14 distinct elements of quality Implementation 2. Four implementation phases 3. Literature aligns around the separate elements of implementation (systematic process that requires a coordinated series of elements) 4. Addressing a number of elements prior to implementation is important (assessment, negotiation, collaboration, planning and critical analysis) 33
  30. 30. The Four Phases of QIF 34 (Meyers, Durlak & Wandersman, in press)
  31. 31. Pre-innovation Training 1 day training in the Resilience Assessment Tool ( RAT) & the Resilience Outcomes Tool (ROT) 1 day training in Practitioner Skills ( Engaging Families; Creating SMART GOALS; Motivational interviewing; Task Lists and Task Analysis; Parent Skills Training ) 6 weeks to start using the tool and collecting data on completed tools prior to training in the Resilience Practices Innovation Training ( 2 days) Co-designed with the Parent Research Centre and the Benevolent Society To learn: about Evidence Informed Resiliency Practice Guides To practice: a selection of the Resiliency Practices Observe , Practice Feedback !
  32. 32. Next Steps ! •Continue detailed project planning to address each QIF element •Design the coaching framework •Identify practice coaches •Train and support the practice coaches •Alignment with other change initiatives in TBS eg. SDMS •Evaluate & monitoring for fidelity and adherence •Learn from the experience ( continuous improvement) 36
  33. 33. Enablers •Senior Leadership commitment to implementing evidence-informed practice •Dedicated project staff •Internal capability with learning and development •External implementation support from the Parenting Research Centre •Common language of practice across child and family services •Dedicated Manager Practice Support positions in some areas •Having data to respond where corrections are needed eg. Supervision Frameworks and Family Assessment Tool •High degree of buy-in from front-line staff 37
  34. 34. Key learning's to date •Keeping everyone motivated and interested for the journey takes enormous energy, commitment and optimism. •Local implementation teams are critical and ensure local solutions and adaptations •Rigorous implementation is hard and requires a high degree of collaboration across the organization. •Resist the temptation to “go live “ too early and just train people without addressing the implementation elements. •Invest now or pay later ! •Practice quality is everyone’s responsibility. •Creating the structures to support the implementation •All the will in the world won’t make it happen without the right authority given to the right staff and with enabling Governance structures in place . 38
  35. 35.