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Los Angeles County Department of Children and Family Services (DCFS)

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1 Los Angeles County Department of Children and Family Services (DCFS)
In partnership with the University Consortium for Children and Families (UCCF) Simulation training for newly hired children Social Workers Presented by harkmore lee, msw director center on child welfare cal. State univ., los angeles

2 Today’s AGENDA The “Sim Team” Brief History & Defining Simulation
Key Elements of Simulation Training Program: Focus on mission, preparation, and demonstration Direction and support from Agency and Schools of Social Work (SSW) Leadership Curriculum Design and Development Implementation and Logistics Research and Evaluation Lessons Learned

3 I) Introducing “the Sim team”
University Consortium for Children and Families (UCCF) Cal State, L.A. - Harkmore Lee, MSW Cal State, Long Beach - James Ferreira, MSW UCLA - Heidi Staples, MSW USC - Donna Toulmin, JD Trainers from all 4 UCCF Partners, e.g. Monica McCurdy, Lilli Miles, Alberto Reynoso, Monica Malin, Ana Sufuentes Los Angeles County Department of Children and Family Services (DCFS) – Training Section Beth Minor Michele Brienze Training Section staff, e.g. Edmarine Edwards, Janae Mankowski Los Angeles Office of County Counsel Tamera Pruitt Law Enforcement Consultant Warren Ondatje

4 II) Brief history 2013: March – Physical design of “residential simulation lab” developed at Cal State LA. Discuss with DCFS staff on potential use. July - Aug: Construction of Residential Simulation Lab “mock up” at Cal State LA DCFS and UCCF trainers observe LE simulations Simulation scenarios created; roles defined and rehearsed. Aug. 29th – First simulation for new CSULA’s RSL Sept–Dec: Simulations are being fully incorporated into academy trainings Other partners, such as County Counsel, PHNs are brought in. Attention from media CSULB begins to create its own simulation environment

5 II) Brief history 2014: Jan-March
LA County Board of Supervisors & Blue Ribbon Commission Reports Cal State LA’s Residential Sim Lab undergoes renovation and upgrade. UCLA begins to create its own simulation environment. April to Present: Cal State LA develops and tests evaluation instruments for simulations. Will design and coordinate evaluation for all sims. USC plans to replicate CSULA’s Residential Sim Lab at their training center. Plans to expand use of simulations to train current CSWs and SCSWs (2,500+ people) over the next two years.

6 What is simulation? “Simulation is a technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (Gaba, 2007) “A method of instruction whereby an artificial or hypothetical experience that engages the learner in an activity reflecting real-life conditions but without the risk- taking consequences of an actual situation is created.” (Bastable, 2008).

7 simulation in action @ the Residential Sim lab at cal state la
February 15, 2015 – NBC-4 Los Angeles Trying new things and not being afraid to fail along the way are more important than what you learn in school. The way we process and think is far more important than specifics taught in a classroom".

8 In general, simulations…
…are designed specifically to promote critical thinking, decision making, analysis and problem solving in a safe, controlled and realistic environment. …provide a bridge from theory to practice. …offer trainees the opportunity to prepare and practice their knowledge and skills, while also receiving constructive and supportive feedback from training faculty. …can help increase confidence and competency

9 key Elements of Simulation Training Program

10 A) Focus on mission, preparation, and demonstration
CHILD SAFETY, PERMANENCY, WELL-BEING INCREASE T.O.L. OF CRITICAL SKILLS AND COMPETENCIES CORE PRACTICE MODEL We are about child safety....In our world of competing demands, we often forget what our true mission is. Instead we come up with various theoretical and complex implementations of training that give OURSELVES validation. You will soon realize with the training we will demonstrate for you that the focus is truly on the STUDENT and not ourselves. In our line of work failure often has dire consequences. Failure is not an option for us in the real world. So, how do we do our best to prevent it. We put the students in life like scenarios where critical thinking and decision making is essential, an environment where there is artificial stress, where consequences are discussed, all in a safe arena where students truly can afford to make mistakes, understand those mistakes and not only learn from them but retain the learned information from the entire process. Prior to with preparation, during with assessment and investigation and after with decision making and documentation.

11 B) Direction and support FROM AGENCY & UNIVErsity SSW LEADERSHIP
PUSH TO INNOVATE NO MORE “DOING BUSINESS AS USUAL” COLLABORATION, COLLABORATION DCFS leadership demanded a new approach to newly hired CSWs with less emphasis on lecture and more real-time skill building in engagement, assessment, problem-solving, critical thinking, and teaming with other professional partners they would encounter in their work at DCFS. Leadership was supportive of innovation, particularly simulation learning, as a way of helping new hires acquire and demonstrate best practice skills. Los Angeles County had developed a shared Core Practice Model with Mental Health and Probation that would inform the skills that simulations would incorporate as key learning objectives. Negative media not functioned as a driver for change, but gave the county an opportunity to show how it had changed its approach to educating new workers. The positive press about simulation learning in LA County has, in turn, become its own driver for the increased use of simulation exercises in all staff development and education.

12 C) CURRICULUM DESIGN AND DEVELOPEMENT
THEORETICAL FRAMEWORKS (KOLB, BANDURA) THEMES, LEARNING OBJECTIVES, FACT PATTERNS SCAFFOLDING AND SEQUENCED LEARNING MULTI-DISCIPLINARY TRAINING TEAMS Curriculum Design Talking Points: The themes and learning objectives were drawn from actual critical incident and child fatality cases provided to the simulation design team by DCFS. H owever the fact patterns were altered to permit learners to avoid replicating a tragic result. The learning objectives for each simulation are clear and limited. The simulations follow the evolution of a case from the first contact at a client’s door, to the investigatory assessment conducted at the beginning of a case, then to critical issues often addressed during continuing services (mental health concerns, substance abuse, IPV) to matters involved in placement permanency and reunification. The simulations are also scaffolded and sequenced to permit learners to demonstrate skills learned in the each simulation to those that follow. The simulations become more difficult and complex as the learner progresses through the sequence. Finally, the multi-disciplinary team involved helps learners to involve the different roles and perspectives that legal, law enforcement, and public health partners play in a child welfare case, and also provides clear answers to questions that arise about personal safety, legal requirements and constraints, mental and physical health concerns, supervisory resources, foster youth perspectives and needs, etc.

13 CRITICAL LEARNING COMPONENTS
BASELINE SKILLS AND STANDARDS SAFE LEARNING ENVIRONMENT READINESS PEER LEARNING TRANSFER OF SKILL-BASED LEARNING Talking Points. Each simulation involves base line skills and standards embedded in a few key learning objectives. Since each learner is different, once someone has properly demonstrated a baseline skill, the actors (who are all Subject Matter Experts) can improvise a more complicated application of the same skill. All learners get a chance to demonstrate an enlarged set of practice skills as later simulations build on earlier ones, and focus on additional practice skills. It is essential to create a safe learning environment without unnecessary observation. Some participants experience difficulty being observed by their peers, let alone an instructor. Additional preparation attends visits by agency executives or media. Readiness involves preparing the class, preparing the facilitation and acting teams, and preparing the organization. Peer to peer learning is a hallmark of our model; a parallel process for our audience and ourselves. The class increasingly experiences peer to peer learning as they experience more and more simulations. At the first, we demonstrate it, later we step back and cue them to provide it to one another. Before and after the simulations, the facilitators, actors and simulation monitors also provide peer to peer feedback, tackling decision making and problem solving together in small and large group formats, and learning for ourselves how to be equally comfortable with criticism and praise. Later simulations build on former ones helping participants to see how they can transfer skills initially learned in one setting to another one, so that transfer of learning can occur from a simulation “stage” to the field. During de-briefing, after a day of simulations, learners can also recount office and home visit experiences and how the simulations have contributed to their performance outside the classroom. One of the main reasons for simulations is the opportunity for its participants to demonstrate how decisions are made or how a problem can be addressed and/or solved.

14 d) Implementation and logistics
BUILDING SIMULATION LAB / SETS “ACTORS” = TRAINERS, SUBJECT MATTER EXPERTS FACILITATOR’S GUIDEBOOK FOR EACH SIMULATION PREPPING AND SCHEDULING Logistics Talking Points: Building a set takes time, space, and resources. In the past year, University partners have developed a range of alternatives in set design from a small home in a classroom to a strip of different “rooms” in a classroom where simulations are conducted, and where students can assess safety, or the presence of indicators that require discussion since they speak to an adult’s capacity to protect and care for children. We have found that a large and dedicated team of professionals involved in child welfare cases are necessary to support this approach. Law enforcement partners have not only helped us understand how to conduct simulations, but have proved invaluable in helping learners understand the difference between being uncomfortable and being unsafe, as well as developing techniques and practices to protect themselves in the field. County Counsel has underscored the importance of constitutional searches, express consent for entry into a home, client confidentiality and required disclosure of an alleged perpetrator, when a life scan is necessary, among other critical practice elements. The universities provide classes on child maltreatment, legal duties, and assessment tools before specific simulation exercises help learners understand how this knowledge can be applied in the field. More recently, Public Health Nurses (PHNs) and foster youth have joined the team of actors and facilitators to provide their expertise and experiences. Scheduling simulations is a complicated task involving assigned actors and subject matter experts to simultaneously occurring exercises that are repeated for different groups of learners in different locations in a training area. Site directors are also identified as time keepers and simulation monitors to keep track of issues that may arise in a particular exercise or group that will require de-briefing later in the day.

15 Construction of 528 sq.ft, 1 bed, 1 ba apt. inside a classroom (csula)

16 Construction of 528 sq.ft, 1 bed, 1 ba apt. inside a classroom (csula)
Residential Sim Lab Construction Costs: Initial Mock-up (Aug. 2013; 3 weeks) = $2,000 (materials, staff labor, props donated) Lab Renovation & Upgrade (Jan. 2014; 6 weeks) = $18,900 (labor, materials to bring up to building code + creation of storage/prop room. Props donated) Installation of AV/Recording/Sounds Effects Equipment for “Closed Set” (Fall 2014) = $ TBD

17 Use of partitions In training room to create sim areas (csulb)

18 Use of partitions In training room to create sim areas (ucla)

19 E) Research and evaluation
HOW DO YOU KNOW IF SIMULATIONS WORK? EXPLORING RESEARCH AND EVALUATION METHODS USED IN OTHER PROFESSIONS WHO USE SIMULATION (E.G. MEDICAL/NURSING, LE, MILITARY) WORK OF MARION BOGO AND MARY RAWLINGS WITH OSCEs (Objective Structured Clinical Examination ) EFFECTIVE EVALUATION METHODS AND RESULTS => SUSTAINABILITY OF SUPPORT

20 f) Lessons learned FLEXIBLE LEARNING IS POSSIBLE WITHIN A STANDARDIZED FORMAT LESS IS MORE KEEP TRAINERS REFRESHED AFTER NEARLY ONE YEAR, PROGRAM IS BOTH EVOLVING BUT “MATURING” Talking points: During the past year, we have education 7 cohorts of new hires. When we decided to include simulations we tried to ensure that each cohort experienced the same “scenes”, and dealt with the same learning objectives, hopefully in the same order as previous cohorts. What we found is that the richness of our subject matter experts lets learning expand to provide flexible learning within a standardized training model. We also were able to expand our collaboration to include California Youth Connections (foster youth) members and a public health nurse in our training teams. We also learned that even though our learners could explore many topics during each simulation, sometimes exploring less meant that they learned more about their clients and caregivers. When we started, we didn’t realize we were helping a learner move from a “check list” approach to one where their assessment deepened as they engaged in conversations with parents, youth, and caregivers.

21 Q & a

22 “Tell me, and I will forget. Show me, and I may remember
“Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand.” Confucius, 450 BC

23 Bibliography Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, Bastable, S. B. (2008). Nurse as educator (3 ed.). Sudbury, Massachusetts: Jones and Bartlett. Bogo, M., Regehr, C., Katz, E., Logie, C., Tufford, L., & Litvack, A. (2012). Evaluating an objective structured clinical examination (OSCE) adapted for social work. Research on Social Work Practice, 22(4), Gaba, D. (2007). The future vision of simulation in healthcare. Quality & Safety in Healthcare, 13(Supp1), i2-i10. Kolb, D. A. (1976). The Learning Style Inventory: Technical Manual, Boston, Ma.: McBer. Kolb D. A. (1984). Experiential Learning experience as a source of learning and development, New Jersey: Prentice Hall. Tokumatsu, Gordon (reporter). (2014, February 15). "DCFS Incorporates Hands-on Training." 6:30 News (television newscast). Los Angeles, CA: KNBC-Channel 4. Retrieved from


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