Presentation on theme: "Evidence into Practice: Implementing a Resilience Practice Framework in Regional and Rural Australia “ We acknowledge that we are meetings on the traditional."— Presentation transcript:
1 Evidence into Practice: Implementing a Resilience Practice Framework in Regional and Rural Australia “ We acknowledge that we are meetings on the traditional country of the Kaura people of the Adelaide Plains. We recognise and respect their cultural heritage, beliefs, and relationships with the land. We acknowledge that they are of continuing importance to the Kaura people living today.”FRSA Conference 2014Wellbeing for Children, Families & Communities:Future Policy, Programs & PracticeAdelaide Convention Centre, November 4 – 6Tanya Spalding Greg AntcliffManager Practice Support Director Professional Practice
2 Outline The Why ? : An organisational approach to practice Uptake of evidence-informed practiceCritical elements approach to evidence-informed practice (EIP)The What? : Resilience Practice Framework (RPF)The How? : Implementation & what we have done ?How effectively are staff Implementing the RPFKey messages
3 The Benevolent Society We help families and children to thriveWe help older people to age wellWe help people take care of their mental healthand wellbeingWe provide learning and education to individualsand organisationsWe work in partnership with communities so theycan build on their strengths and use their own resourcesWe advocate and speak out for a just societyAs stated on the slide TBS is Australia’s first charityWe help older families and children to thriveWe help older people to age wellWe help people take care of their mental health and wellbeingWe provide learning and education to individuals and organisationsWe work in partnership with communities so they build on their strengths and use their own resourcesWe advocate and speak out for a just society
4 The Brighter Futures Program Early Intervention with families with children aged <9 yrs, or who are expecting a child, where the children are at high risk of entering the child protection system.A voluntary program with multiple referral pathwaysProgram Outcomes; improve the emotional, social, health, educational and developmental outcomes for families and their children.Service components: case management, home visiting and parent skills coaching. Access to child care, parenting programs and brokerage (e.g. material/financial aid, fee for service).Brighter Futures is a voluntary early intervention program that seeks to identify families at risk earlier and prevent them from entering the child protection system by providing them with sustained services and support that will help prevent problems from escalating and achieve long-term benefits for children.The Brighter Futures program has a strong evidence base. Key international and national research findings which underpin the rationale and design of the program include:• early intervention programs that use multiple interventions work better than those using a single intervention strategy• quality early intervention programs enable the most vulnerable children to make significant development gains• home visiting can achieve gains for parents, particularly first time mothers and positive effects on children’s development• parenting programs reduce child behaviour problems and parental stress• one-off interventions at a particular development stage are unlikely to have a lasting effect in protecting high risk individuals where as sustained support is more likely to deliver long term outcomes.The Brighter Futures program aims to:• reduce child abuse and neglect through reducing the likelihood of family problems escalating into crisis within the child protection system• achieve long term benefits for children through improving intellectual development, educational outcomes and employment chances• improve parent-child relationships and the capacity of parents to build positive relationships and raise stronger, healthier children• break inter-generational cycles of disadvantage• reduce demand for services that otherwise might be needed down the track such as child protection, corrective or mental health services.
6 Our Regions are based on NSW Health Districts Our Regions are based on NSW Health Districts. Western NSW contains 33 LGA’s that can be broken down into the following Regions:Nepean Blue Mountains: Penrith, Blue Mountains, Hawkesbury, LithgowWestern: Mid Western Regional, Bathurst, Oberon, Blayney, Orange, Cabonne, Cowra, Parkes, Forbes, Weddin, Bland, Lachlan, Wellington, Dubbo, Narromine, Warrumbungle, Gilgandra, Warren, Bogan, Cobar, Coonamble, Walgett, Brewarrina, BourkeFar West: Broken Hill, Central Darling, Unincorporated, Wentworth, BalranaldThe Nepean Blue Mountains covers just under 9,200 km2 with a population of 345,000; Western is in excess of 250,000 km2 with a population of 271,000, the Far West is nearly 195,000 km2 with a population of 30,000. In total the Region covers in excess of 450,000 km2.• Socio-Economic Indexes for Areas (SEIFA) is a product developed by the ABS that ranks areas in Australia according to relative socio-economic advantage and disadvantage. The average in Australia is Every LGA in our Region is below this. The lowest is Brewarrina (near Bourke) is 788.• High Aboriginal Population – the Western Region has 9 Nations, the biggest being Waradjuri, and it is the biggest nation in NSW , 9.4% identify as Aboriginal as opposed to 2.5% in NSWWestern Region Brighter Futures StaffBrighter Futures Program has been running in the Western Region since 10 April 2007 There are teams at 5 different locations in the Central West.16 Staff, 2 Team Leaders, 2 Managers, 1 Practice ManagerThe staff come from a range of disciplines with both degrees(professional) and non-degree(para-professional) qualifications in psychology, social work, welfare and community services, early years education and teaching.
8 The need for an organisational approach to our work When our service delivery was Sydney-based, our practice was generally consistent because we had lots of opportunities to sit around a table and discuss the theory that informs our practice.But over the past 10 years, The Benevolent Society has grown, expanding into Rural & Regional NSW and Queensland. We don’t have the same opportunities to gather together and talk about how we do things any more.Because we are more spread out we need to adjust our approach.We need to make sure that we’re all marching to the beat of the same drum.That’s why we are introducing the Resilience Practice Framework. To bring our children and family practitioners together under a common language and theoretical framework.We are introducing ‘resilience’ as the overarching structure under which our current evidence based theories will sit.
9 What is Evidence Informed Practice? 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.Evidence-Informed practice has been defined as:“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 delivered’EIP is a concept which has been increasingly cited in the community service arena in recent years. It is based on the principle that community service programs and interventions should be informed by the most current, relevant and reliable evidence.The Origins of EI Practice lie in the health field, which are driven by orgs like the Cochrane Collaboration who run systematic reviews to establish an evidence base for drug interventions, and similarly the Campbell Collaboration who focus on social and educational interventions.Adapted from What Works for Children?Evidence Guide. Economic & Social research Council et al 2003
10 Uptake of Evidence-Informed Practice Working with vulnerable families at risk of abuse and neglect is intensive and challenging work for family support practitioners.There are many evidence-informed programs and interventions which have been shown to be effective but for many reasons, the best evidence informed practices are not always being delivered directly to familiesTodays webinar will:Examine what EIP and the reasons why it is not always reaching familiesDiscuss the process of implementation, and how far the Benevolent society has come in embedding evidence-informed practices into their programs
11 Evidence Informed Practice (EIP) EIP is the expected approach to improving the quality of practice and service deliveryFor 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 supportMany programs and practices found to be effective in child and family support fail to translate into meaningful outcomes across different service settings
12 Research to Practice Gap World of ResearchWorld of PracticeNot just in UK, we too, have to Mind the Gap…In the community services sector, there is a significant gap between what are known to be effective interventions for children and families (research) and what is being delivered on the ground (practice). This is known as the research to practice gap. Barriers to achieving evidence informed practice occur at a systems level, organisational level and at the individual practitioner level. Even where there is a high quality evidence base to inform practice, the incorporation of this into practice is frequently low, slow, incidental or haphazard.Traditional methods to facilitate the engagement of practitioners in evidence-informed practice (such as stand-alone training) have been demonstrated to be ineffective on their own. A more structured process that addresses systemic and organisational issues is required to make sure new practices are implemented.ImplementationAdapted from Riley, 200512
13 Critical barriers to EIP Organisational setting or contextThe capacity of the workforce to implement EIPAddressing organisational polices and processesNarrow project, practice standards, guidelines, or procedure-orientated approach to introducing evidence (Johnson & Austin, 2006)
14 Evidence-based practice and programs Collections of practices that are done within known parameters (philosophy, values, service delivery structure, and treatment components)PracticesSkills, techniques, and strategies that can be used by a practitioner.Common elements or practice components/kernals(Chorpita et al; ( Embry, 2004)It was all well and good to find the programs which the literature told us worked, but the next step was to find out was what made them work. Were there common elements in these programs and interventions which could be identified?It should be noted that while a program can be conceptualised as a collection of practices performed within a theoretical structure or format, practices are the specific skills, techniques and strategies a practioner uses within the program of treatment.So it was the effective practices themselves within that we needed to identify.
15 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
16 “Evidence” on effectiveness helps you select what to implement for whom however“Evidence” on these outcomes does not help you implement the program or practiceFixsen & Blase (2008)Evidence helps identify the what but doesn’t tell you how
17 The What ? :Resilience Practice Framework and developing the evidence informed practices
18 Resilience Practice Framework Resilience is the overarching approach to the Benevolent Society’s work across child and family services. We define Resilience as : “Strength in the face of adversity. The capacity to adapt and rebound from stressful lie events, strengthened and more resourceful.”
19 Resilience Practice Framework The RPF focuses on maximising the likelihood of good of better outcomes for children by building a protective framework around themIt identifies six domains of a child’s life that contribute to the factors known to be associated with resilience (Antcliff, Daniel & Burgess, 2014)The framework was adapted to align with the agency’s purpose and strategyThe goal of adopting an organisation-wide framework was to achieve a shared approach to child and family practice across diverse services and geography, and improve the consistency and quality of practice.
31 Implementation Science Implementation occurs in stages:Exploration & AdoptionInstallationInitial ImplementationFull ImplementationInnovationSustainabilityFixsen, Naoom, Blase, Friedman, & Wallace, 20052 - 4 YearsThese are the stages through which almost all implementation initiatives travel, and each stage of implementation does not cleanly and crisply end as another begins. Often they overlap with activities related to one stage still occurring or re-occurring as activities related to the next stage begin. And depending on the factors and variables in the environment, implementation efforts may completely drop back to an earlier stage. For example, if there is significant staff turnover at the practitioner level, then the effort may move from an effort that is fully implemented back to an effort or initiative that is again in the stage of initial implementation.Exploration and AdoptionArticulate the need for an Organisational approach to our workDiscuss at Operations meeting and fit with Strategic PlanAdoption at a leadership level – Senior Managers and GM OperationsDefine evidence base and evaluation FrameworkProject Scoping – Paper (internal Operationalising Resilience)Prgram InstallationStakeholder Analysis – Define stakeholder groups to inform future planningChange process designedDevelopment of Communications PlanDevelopment of Learning and Development PlanPilot TrainingDevelop Learning Circle FrameworkBrief learning Circle leadersEvaluation Plan for Learning & DevelopmentEngage Regional LeadsDevelop Evidence Based Resources and toolsInitial ImplementationImplement Resilience Learning and DevelopmentCirculate tool kits for managers and Learning Circle LeadersCommunication Plan implementedFull OperationLearning Circles implementedResilience reflected in all Area and service Business PlansPosition Descriptions reviewed to reflect Resiliecne Practice FrameworkPDR process reviewed to reflect practice frameworkInnovationLearning Circles evaluation and reviewedExplore the application of Resilience Practice Framework across lifespanSustainabilityE-learning module developedRound table wih stakeholdersBusiness Systems review for development of future Information SystemsRepeat survey of staff and compare results from base line data31
32 The Four Phases of QIF(Meyers, Durlak & Wandersman, 2012a)
33 Implementation Drivers Once EIP’s have been developed, close attention needs to be paid to the process of implementation. In recent year, researchers have increased their efforts to outline the porcess of Implementation. These have often been in the form of descriptions of the main steps in implementation and / or refined conceptual frameworks based on research literature and practical experiences ( i.e., theoretical frameoworks, conceptual models) .Frameworks for implementation are descriptors of the implementation process including key attributes, facilitators, and challenges to implementation ( flaspohler et al, 2008). They provide an overview of practices that guide the implementation process and in some instances, can provide guidance to researchers and practitioners by describing specific steps to include in the planning and / or execution of implementation efforts, as well as pitfalls or mistakes that should be avoided ( Myers, et al., 2012).
34 Phase 2 : Key Implementation Activities 2013 -2014 Undertake readiness assessmentsPractice contextualising sessions for each siteFormation of Local Implementation Teams ( technical)2 days training in the Resilience Assessment Tool and Outcomes Tool2 days training (Observe, Practice , Feedback) in a selection of Resilience Practices from each outcomeRefinement of positionsUsing the RPF in the Recruitment phase for new staffFormation of Group coaching structuresIdentify Practice support functionsData collection – frequency of use and Outcomes data collectionInformal review of policies and procedures
35 Training framework Training Session Purpose Attendees Duration TimeframeRAT and practitioner skillsOverview of RAT and practitioner skillsAll staff2 daysApril-Aug 2013Module 1 EIP trainingOverview of selected EIPsAug- October 2013Module 2 EIP training(3-4 mini modules) Delivered via learning circles1–2 daysNot yet scheduledCoaching skillsOverview of coaching skillsCoaches1 dayDecember 2013The core component of Training was also addressed by the LIT and the Western Region was the first in the organisation to deliver this component.It consisted of:2 days training in the Rat (including staff and management) in April 20132 days training in the EIPs (staff and management) August 20131 day coaching skills delivered in Dec 2013 (delivered after coaches were expected to be coaching)As yet Ongoing training modules have not be schedules in any of the regions.The LIT was keen to keep staff’s motivation and commitment levels high and so elected to attend the training along with the staff. Managers did later report ongoing challenges associated with receiving the training at the same time as staff. They argued that prior LIT training and/or support in the tools and practices before staff training would have increased their confidence and knowledge when providing ongoing support to their teams. Staff also identified the importance of management being familiar with the tools and practices in order to provide effective coaching support.Staff feedback was generally positive with the only suggestion being that they would have liked agendaIn the recent evaluation interviews the LIT and staff provided mixed feedback regarding the timeliness of the training sessions. The majority of LIT members reported that the four month gap between the training sessions was too long. Other members of the LIT and staff reported that the gap was timely as it allowed staff time to familiarise themselves with the tool before moving onto the practices.CoachingManagers also reported that they had received mixed messages from the organisation about whether they were required to coach the RPF product (content knowledge) or coach the person (supervision). They suggested that the coaching framework needs to clearly align with HR initiatives, such as position descriptions, performance agreements and the organisational engagement survey Gallup Q12.LIT also expressed concerns that managers and team leaders were expected to be content experts in the RPF in order to effectively coach staff. This was compounded by coaches learning the tools and practices at the same time as staff.Having coaches (team leaders and managers) labelled as ‘experts’ may also devalue staff skills and expertise, when staff have more experience working directly with clients.A suggested solution to these concerns was incorporating a peer based coaching component into the RPF coaching framework. This option is to implemented at a later date once Practice Champions are identified, and they feel they would like to participate in these forums.Despite the positive feedback on localised implementation the LIT identified a need for local processes to be connected to a broader organisational implementation plan. Without that connection there was no clear understanding of how the RPF implementation fitted with other competing organisational priorities and initiatives.Staff reported that although implementation activities, such as training timelines, had been clearly communicated to them throughout the implementation process they were unsure what was happening now that some of the training had occurred and feared that management was also unclear. This suggests that further communication to staff about upcoming implementation activities is required to ensure ongoing buy-in, however the challenge is providing dates when the training has not been scheduled by the Central Implementation Team.
36 Coaching Framework Mechanisms Purpose Who Frequency Duration Individual supervision and coachingProvides individual coachingAll staffFortnightly1 hourGroup coaching sessionsSkill development attached to case presentations – responsive to practice – ‘observe, practice, feedback’All staff – small groups ; led by Team Leaders or Practice MgrsMonthly2 hoursCoaching supportProvide support for coaches to help develop coaching skills and technical competencies; themed around outcomesCoachs’ technical practice expertise tbc (long term plan to up skill a group of TLs but may need external input for a period of time)2 hours; 6– 9 monthsLearning circles‘Top up’, exposure to EIPs not trained on to date; ongoing support around use of RAT tools, flexible to meet the needs of the staff, Module 2 EIP (see above formal training)All staff – bigger groups from across the regionQuarterly½ day; 3–4 sessionsIn the Western Region the Learning and Development structures had already been established by the Practice Support Manager prior to the roll out of the second phase of the RPF, and it was through these structures the LIT agreed to implement the core component of Coaching.With the roll out of the Training around the revised Resilience Assessment Tool and Evidence Informed Practices, the LIT agreed to change the name of the Group Supervision sessions to Group Coaching to focus on the elements of the RAT and Practices.Individual coaching through the function of supervisionGroup coaching sessionsLearning circlesCoaching support for coachesthe LIT reported that coaching mechanisms including learning circles, group sessions and observations during home visits had been established quickly after training. Although learning circles and groups sessions were facilitated by the Practice Support Position all managers and team leaders also attended each session. This ensured that knowledge and messages were consolidated in team meetings, one on one coaching and supervision.A strength in the Western region was the establishment of coaching mechanisms (observations, learning circles, group sessions and one-on-one coaching) quickly after training.The LIT also believed having a role focussed on practice was a critical factor to support not only the RPF implementation but also overall quality of practice in the region. Having a practice function that was not responsible for (but linked to) line management was seen as highly beneficial to ensure there was practice consistency across the region.The LIT also believed that practice observations were a critical component of the coaching framework. At the time of the interviews all members of the LIT had observed staff during a home visit. The LIT reported that the observation process and experience had increased practice transparency and accountability, encouraged practice sharing and had provided management with the opportunity to acknowledge staff skill and good practiceThe LIT also identified that practice observations were a critical component of the coaching framework. At the time of the interviews all members of the LIT had accompanied staff during a home visit. The LIT reported that the observation process and experience had increased practice transparency and accountability, encouraged practice sharing and had provided management with the opportunity to acknowledge staff skill and good practice. As such the LIT perceived that practice observations had strengthened staff engagement in the management team. One team leader said,Lately I’ve been putting it on the agenda for team meetings, so we’ll sit down and discuss different practices and bring resources along to compliment that practice, and talk about our experiences with that practice, whether we’ve actually used it.”
37 How is the RPF implementation tracking in the Western Region? In terms of the development and monitoring of ongoing training and coaching the LIT identified that this task was being undertaken by the Practice Support Manager. The LIT argued that without this position in place the responsibility of ongoing training and coaching in the RPF tools and practices would not be clear and would not be possible with existing resources.
38 Is there buy-in from the local leadership team and frontline staff in the Western region? The results of the online survey indicate that buy-in from the leadership team and staff in the Western region has increased since To determine changes in buy-in the 2014 online survey included five statements previously administered in the 2012 Readiness for Change survey.As shown there was an overall increase in the proportion of staff and LIT members that agreed with all statements. The greatest increase was for the statements our senior leaders have encouraged us to embrace this change and that the RPF will improve the organisations overall efficiency.Again the Western team was more likely to agree than TBS with all statements. The biggest difference in agreement were for the statements the RPF will improve the organisations overall efficiency and every senior manager has stress the importance of this change.
39 Does the RPF fit the needs of the region? The online survey asked a number of statement to determine if the RPF fit the needs of the region, clients and the broader organisation.The LIT reported that the RPF had addressed the historic lack of practice transparency and accountability in the region. They reported that the RPF provided role clarity on what is expected of staff working in the Brighter Futures program, clear tools to support practice and data to evidence client outcomesStaff in the Western region also reported an increase in practice consistency across sites. Staff identified that the RPF provided them with a common language and meaningful structure. As such, they were more purposeful in their home visits and better able to accurately document their work with clients. Further benefits included being better able to explain the program to other service providers and being able to discuss and review outcomes with clients.
40 Resilience Assessment Tool Mixed levels of confidence using the tool in practiceProvided a lot of information in a short amount of timeChallenges completing the tool with clients with mental health issues and low literacy levels (visual resources)Identifying client goals and relating them to resilience outcomes and practicesPositive six month review processOnline survey results suggest that staff in the Western region are confidently using the RAT.All staff respondents agreed that they :Were able to select and use conversation promptsFelt confident using the ROTAble to match client’s strengths and needs to appropriate resilience practicesStaff respondents were least likely to agree that they are able to have a support plan developed within the specified timeframeIn the evaluation interviews staff and the LIT reported mixed levels of confidence and competency using the RATExamples of excellence included staff members effectively analysing information, developing a support plan and selecting appropriate practices.However, some staff members were using the tool rigidly with clients.In one case it was reported that the tool was being left with clients to review and completeThe LIT reported that policies and procedures that detail how the tool should/shouldn’t be used with clients would be beneficial to increase practice consistency across the regionAlthough staff reported that the RAT was comprehensive, providing them with a lot of information in a short amount of time, they also reported challenges completing the tool with clients who had mental health issues or low levels of literacyIn some cases staff reported that they felt rushed having to gather all the information quickly and found the process disrespectful to clients who wanted to tell their story in their own timeA suggested solution to these challenges was the development of visual resources that explain the program, assessment process, RPF philosophy, resilience outcomes and practices to clients.Staff also reported challenges identifying client goals and relating them to the resilience outcomes and practices.They suggested that the support plans were too broad due to the emphasis on high level outcomes and do not accurately capture client’s goals or specific tasks other than the resilience practicesStaff said that they experienced challenges communicating the support plan goals to clients who were not able to relate to the resilience outcomes or the language that is required to be used in the support plan.A common reaction from clients was reported to be ‘I didn’t say that was my goal’.Staff also reported being frustrated with the formatting of the tool. This was as a result of being a pilot site and the staff were able to feed back and have changes made, however it was challenging controlling which draft was the most up to date.Challenges with analysisIdentifying client goals and relating them to resilience outcomes and practicesDuring the interviews staff were also asked how clients were responding to the RAT.Although staff reported that the structure could be initially overwhelming for some clients, once clients understood the purpose of the tool and the link to the practices most were willing to engageIn addition, one staff member provided an example of a client who realised that, through the completion of the Resilience Assessment Tool, they did not in fact need to continue the service.Finally, both the LIT and staff members identified that the six month review process of the RAT was helpful to initiate conversations with clients about how they are progressing on the programStaff members reported that the review of goal achievement and ROT was useful for client engagement and for them as workers to identify and track changes in client outcomesThe information that is gathered in a short amount of time is great, having a constructive home visit is great and the outcome and review is wonderful to capture the progress I am having with my families.” (Staff)
41 How confidently and competently are staff using the resilience practices? The online staff survey results suggest that staff in the Western region are confidently delivering the resilience evidence informed practices (EIPs). As shown in Figure X, 8 out of 9 staff respondents agreed that they felt confident explaining the rationale to families and that they have the necessary content knowledge and technical skills to deliver the practices. In addition, 7 out of 9 respondents agreed that they felt confident delivering the practices to families.Online Survey Results: Staff
42 Self-Reported Competency Checklist- Practice Guides To measure staff competency, the practice support manager designed a simple Self Reported Competency Checklist which was completed by staff (including the LIT) just after the EIP training in August/September 2013 (T1 ). To measure changes in staff competency the Checklist was re-administer in February 2013 (T2). These results suggest that staff competency in each of the practices has increased from T1 to T2. The greatest positive change over time was for the following Practice Guides:Increasing coping/self regulation (0.80)Increasing Self-Efficacy (0.78)Improving Empathy (0.76)The results also highlight the practices that staff felt most and least competent delivering.In February 2014 staff reported that they were most competent (highest 5 means) delivering the following practices:Basic child health care (4.69)Supervision children (4.69)Descriptive praise (4.62)Effective rules (4.58)Physical exercise adult (4.54)Staff reported being least competent (lowest 5 means) in the following practices:Parenting skills (3.69)Strategies to challenging negative thinking traps (3.77)Challenging negative thinking (3.85)Motivational interviewing (3.91)Identifying negative thinking traps (3.92)In the evaluation interviews the LIT reported that Improving Empathy and Increasing Coping/Self regulation were the most challenging Practice Guides for staff.It was also widely reported that staff were only delivering the practices that have been covered in training/coaching or the practices that they were most comfortable delivering.In the interviews staff reported that the process of gaining competency and confidence delivering the practices was ongoing, with some still unsure whether they were delivering the practices how they were meant to be delivered.In addition, few staff reported delivering each step of the practices.This result may reflect the fact that the main focus of coaching sessions had been increasing staff skill and confidence delivering the practice rationale to clients.The LIT believed that if staff did not understand the rationale of each practices they struggled to explain the practices to clients and were unable to effectively deliver each of the practice steps.Similar to the outcomes, staff also identified challenges delivering the practices to clients with high risk, complex needs.Staff reported that the practices were most effective when they had built up the rapport and trust with the client and when the client is not is crisis.Although staff planned to deliver the practices it is not always possible in complex situations. Examples that were reported included family violence situations or when the client was experiencing mental health issuesDespite these challenges staff reported that they were now starting to understand how all the practices fit within the framework. As such, they reported that their confidence delivering the practices had increased substantiallyFinally, staff reported that clients were reacting positively to the practices, being “open to it a lot of the time”. In particular, staff reported that clients were responding positively to the structure and the language used in the guides.
43 In the Words of the Staff “Those structures have been really key, so that it’s been easy to implement it. Then because out here we have our managers and team leaders attend group supervision, or group coaching, consolidated it, because then those are the discussions that they can have with individual staff.” (LIT) “I would imagine that there’s a direct correlation between the people who use the Practice Support position and the people who are getting good outcomes, and the people who are taking on board the practice.” “Yeah, it worked quite well to be honest. I see now that, had it been part of the organisational implementation plan, I’d be feeling a lot more secure…But it worked really well for- we were all engaged, we were all on board, we were all holding each other to account.”Coaching
45 Practice Recommendations Provide further support about staff use of the RAT (timeframe, recording other tasks, assessing clients with complex needs).Staff needed a best practice example of the RATProvide ongoing coaching to increase staff skill and competence delivering each step of the practices.Provide staff with ongoing time to familiarise themselves with RPF tools and practicesConduct regular home observations (increase 2 year min)Implement a peer based coaching componentProvide staff with opportunities to share practice within and across regionsTime to consolidate PracticeOngoing evaluationThe development of policies and procedure about how the tool should/shouldn’t be used with clients will increase practice consistency across the region. Ongoing support about how to complete the tool within the specified timeframe, how to record tasks other than the resilience practices, and how to engage and assess clients with complex needs would also be beneficial to increase staff confidence and competency using the tool. There is Practitioner Guide to using the RAT but there is need for it to be more formalised. This is not just an issue for the Western Region and may be addressed by another TBS working party.Both staff and the LIT suggest that an example of a Resilience Assessment Tool that has been completed to a high standard would increase staff skill completing the tool. Having a best practice example would assist staff understanding of how to gather and analyse information, develop a support plan and link client goals to the resilience outcomes and practices.The results from the recent evaluation demonstrate the importance of maintaining ongoing coaching sessions, that focus on increasing staff skill and competence delivering the resilience practices. This will ensure that staff confidence and competency delivering the practices continues to increase.It is important that time for existing and new staff to familiarise themselves with the tool and practices is ongoing and encouraged. The Western region LIT has continuously promoted staff to take this time during work hours so that staff do not have to spend their own time (outside of work hours) familiarising themselves with the RPF in order to confidently deliver it to clients. This has been key in their verbal as well as written communication pieces and is recommended as an ongoing commitment to practice.A peer based coaching forum as well as a forum to share practices across the regional sites were identified early on by the LIT. Some of this already occurs in the Learning Circles and Group Coaching sessions but it will be beneficial to dedicate a forum just to this function. This has been on the Practice Managers agenda but it was decided by the regional manager to wait until some of the changes in practice have been consolidated. It is hoped that this will be able to be part of the learning and development structures in the Western region by the end of 2015.A consolidation period in the Western region is necessary to ensure that staff members don’t continue to experience change fatigue and most importantly have the opportunity, resources and time to embed the RPF into their day to day practice. The LIT has started to develop a Performance Improvement Plan to support the resources needed by the region as part of this consolidation period. It is also committed to participating in ongoing evaluation to ensure we are providing the best evidence informed service we can to the children, families, and communities in the Western region of NSW.
46 EnablersSenior Leadership commitment to implementing evidence-informed practiceDedicated project staffInternal capability with learning and developmentExternal implementation support from the Parenting Research CentreCommon language of practice across child and family servicesDedicated Practice SupportHaving data to respond where corrections are needed eg. Supervision Frameworks and Resilience Assessment ToolHigh degree of buy-in from front-line staff
47 Key learnings to dateKeeping everyone motivated and interested for the journey takes enormous energy, commitment and optimism.An over reliance on training is a waste of organisational money as it doesn’t yield practice change unless accompanied by systems, process change and coaching.Rigorous implementation is hard and requires a high degree of collaboration across the organisation.Articulate the theory of change and what the end game looks likeInvest now or pay later !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 .Studying the development and implementation of the RPF provides an opportunity to advance real world implementation of EIP’s within a large community service organisation.
48 Limitations of the Approach EIP’s developed for the Resilience practice Framework have not been bought together before and the packaging up of these practices to be used by practitioners is untested ( Outcome and process evaluation will determine this)Implementing the Resilience Practice Framework has been slow and its innovative nature means that it can be hard for staff within the agency to trust the approach will reap the rewardsThere has been no cultural adaptation of the EIP’s for aboriginal and Culturally & Linguistically diverse families ( planned but not commenced)
49 “It is not always what we know or analysed before we make a decision that makes it a great decision. It is what we do after we make the decision to implement and execute it that makes it a good decision.” William Pollard