Presentation on theme: "Evidence into Practice: Implementing a Resilience Practice Framework in Regional and Rural Australia FRSA Conference 2014 Wellbeing for Children, Families."— Presentation transcript:
Evidence into Practice: Implementing a Resilience Practice Framework in Regional and Rural Australia FRSA Conference 2014 Wellbeing for Children, Families & Communities: Future Policy, Programs & Practice Adelaide Convention Centre, November 4 – 6 Tanya Spalding Greg Antcliff Manager Practice SupportDirector Professional Practice
The Benevolent Society We help families and children to thrive We help older people to age well We help people take care of their mental health and wellbeing We provide learning and education to individuals and organisations We work in partnership with communities so they can build on their strengths and use their own resources We advocate and speak out for a just society
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 pathways Program 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).
Western Region NSW
Phase One : The Why ?
The need for an organisational approach to our work
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.
Uptake of Evidence-Informed Practice
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
Adapted from Riley, 2005 World of Research World of Practice Research to Practice Gap Implementation
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)
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)
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
“Evidence” on effectiveness helps you select what to implement for whom however “Evidence” on these outcomes does not help you implement the program or practice Fixsen & Blase (2008)
The What ? : Resilience Practice Framework and developing the evidence informed practices 17
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.”
Resilience Practice Framework The RPF focuses on maximising the likelihood of good of better outcomes for children by building a protective framework around them It 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 strategy The 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.
Knowledge to Implementation Cycle
What is the RPF ? Resilience domains Resilience Outcomes & Indicators Increasing Safety Secure and Stable Relationships Improving coping / self regulation Improving empathy Increasing self efficacy 47 Evidence Informed Practices (EIP’s) Resilience Assessment Tool Resilience Outcomes Tool Specialist Practice Guides
Summary Resilience Practice Framework
Resilience Guides 1-6
Specialist Guides 7 & 8
The How ? : Implementation
Implementation Science Implementation occurs in stages: Exploration & Adoption Installation Initial Implementation Full Implementation Innovation Sustainability Fixsen, Naoom, Blase, Friedman, & Wallace, Years
The Four Phases of QIF (Meyers, Durlak & Wandersman, 2012a)
Phase 2 : Key Implementation Activities Undertake readiness assessments Practice contextualising sessions for each site Formation of Local Implementation Teams ( technical) 2 days training in the Resilience Assessment Tool and Outcomes Tool 2 days training (Observe, Practice, Feedback) in a selection of Resilience Practices from each outcome Refinement of positions Using the RPF in the Recruitment phase for new staff Formation of Group coaching structures Identify Practice support functions Data collection – frequency of use and Outcomes data collection Informal review of policies and procedures
Training framework Training SessionPurposeAttendeesDurationTimeframe RAT and practitioner skillsOverview of RAT and practitioner skills All staff2 daysApril-Aug 2013 Module 1 EIP trainingOverview of selected EIPs All staff2 daysAug- October 2013 Module 2 EIP training (3-4 mini modules) Delivered via learning circles Overview of selected EIPs All staff1–2 daysNot yet scheduled Coaching skillsOverview of coaching skills Coaches1 dayDecember 2013
Coaching Framework MechanismsPurposeWhoFrequencyDuration Individual supervision and coaching Provides individual coachingAll staffFortnightly1 hour Group coaching sessions Skill development attached to case presentations – responsive to practice – ‘observe, practice, feedback’ All staff – small groups ; led by Team Leaders or Practice Mgrs Monthly2 hours Coaching supportProvide support for coaches to help develop coaching skills and technical competencies; themed around outcomes Coachs’ technical practice expertise tbc (long term plan to up skill a group of TLs but may need external input for a period of time) Monthly2 hours; 6– 9 months Learning 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 region Quarterly½ day; 3–4 sessions
How is the RPF implementation tracking in the Western Region?
Is there buy-in from the local leadership team and frontline staff in the Western region?
Does the RPF fit the needs of the region?
Resilience Assessment Tool Mixed levels of confidence using the tool in practice Provided a lot of information in a short amount of time Challenges 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 practices Positive six month review process
How confidently and competently are staff using the resilience practices? Online Survey Results: Staff
Self-Reported Competency Checklist- Practice Guides
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.”
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 RAT Provide 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 practices Conduct regular home observations (increase 2 year min) Implement a peer based coaching component Provide staff with opportunities to share practice within and across regions Time to consolidate Practice Ongoing evaluation
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 Practice Support Having data to respond where corrections are needed eg. Supervision Frameworks and Resilience Assessment Tool High degree of buy-in from front-line staff 46
Key learnings to date Keeping 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 like Invest 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.
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 rewards There has been no cultural adaptation of the EIP’s for aboriginal and Culturally & Linguistically diverse families ( planned but not commenced)
“ 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