Facing reality: What it Takes to implement systems change

Transcription

FACING REALITY: WHAT IT
TAKES TO IMPLEMENT
SYSTEMS CHANGE
2010 Policy to Practice Dialogue
Session Overview
Introduction to Implementation Centers
Understanding Implementation Science
Experiences in Implementing Systems
Change and Implications for States
Reflections on Lessons Learned

Introduction to the Implementation
Centers
Marketa Garner Gautreau
Western and Pacific Child Welfare
Implementation Center
Implementation Centers and
National Resource Centers
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Funded by the Children’s Bureau to provide States and Territories, Tribes, and Tribal Consortia individualized training and technical assistance (T/TA) to:

Improve child welfare administration and practice
Meet Federal performance standards and implement effective
programs
Pursue sustainable and positive systems change
Improve outcomes for children, youth & families
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Implementation Centers:
Filling the Gap
States and Tribes are sometimes without the resources necessary to implement comprehensive strategic plans
National Resource Centers have limited resources to provide intensive, long‐term TA Implementation Centers provide in‐depth and long‐term consultation and peer networking opportunities to States and Tribes Key Features
Possess expertise in implementation strategies, systemic
intervention, and the process of organizational and systems
change
Operate in defined geographic service areas comprised of two
ACF Regions
Enter into mutually binding agreements for implementation
projects to provide in-depth, long-term technical assistance and
resources to selected project sites
Provide peer networking opportunities to all states and tribes in
the defined service areas (two ACF Regions)
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Geographic Assignments
Who are the Implementation Centers?
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Implementation Center Organization Northeast & Caribbean Implementation Center (NCIC)
University of Southern Maine, Muskie School of Public Service Atlantic Coast Child Welfare Implementation Center (ACCWIC)
University of Maryland School of Social Work
Midwest Child Welfare Implementation Center (MCWIC)
University of Nebraska‐Lincoln, Center on Children, Families & the Law Mountains & Plains Child Welfare Implementation Center (MPCWIC)
University of Texas, partnering with the University of Colorado (Denver) and The Native American Training Institute (NATI)
Western & Pacific Child Welfare Implementation Center (WPIC) American Institutes for Research, partnering with National Indian Child Welfare Association, Center for the Study of Social Policy, National Technical Assistance Center for Children’s Mental Health at Georgetown University, and the Florida Mental Health Institute at the University of South Florida
Learn More
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Implementation Centers
Northeast & Caribbean Implementation Center (NCIC)
Website http://ncic.muskie.usm.maine.edu
Atlantic Coast Child Welfare Implementation www.accwic.org Center (ACCWIC)
Midwest Child Welfare Implementation Center (MCWIC)
www.mcwic.org Mountains & Plains Child Welfare Implementation Center (MPCWIC)
www.mpcwic.org Western & Pacific Child Welfare Implementation Center (WPIC) www.wpicenter.org
Understanding Implementation
Science
Cathy Fisher
Atlantic Coast Child Welfare
Implementation is not a Hobby!

There is a body of research around effective
implementation.
Child welfare is slow to apply the science.
Implementation Centers are utilizing
methodology to support project work with
states and tribes.
What do we know?

Implementation Science
National
(NIRN)

Phases of Change
John

Implementation Research Network
Kotter, Harvard Business School
Managing Change
ADKAR
Model (Awareness, Desire, Knowledge,
Ability and Reinforcement)
Process
Implementation
putting new
operating procedures
in place to conduct
training workshops,
provide supervision,
change information
reporting forms, and
so on with the
adoption of an
innovation as the
rationale.
PERFORMANCE
Paper
Implementation
putting into place
new policies and
procedures with the
adoption of an
innovation as the
rationale.
PROCESS
PAPER
Degrees of Implementation
Performance
Implementation
putting procedures
and processes in
place in such a way
that the identified
functional components
of change are used
with good effect for
consumers.
Implementation Research: A Synthesis of the Literature
The National Implementation Research Network
Stages of Implementation
Exploration
Design/Installation
Initial
Implementation
Full
Implementation
Sustainability
Adapted from Implementation Research: A Synthesis of the Literature (2008) The National Implementation Research Network
Stages of Implementation
Core Activities
Exploration
• Conduct
organizational
assessment
• Garner leadership
and stakeholder
support
• Review literature
• Solicit multiple
perspectives on
needs and
opportunities
• Establish baseline
performance
• Develop
intervention model
Design/Installation
Initial Implementation
• Develop plans:
• Implementation
• Communication
• Change
management
• Define goals and
benchmarks
• Engage
stakeholders
• Conduct readiness
assessment
• Align organization
systems/supports
• Build staff
competency
• Communicate
project status
• Monitor fidelity of
implementation
• Monitor
implementation
climate
• Identify and
address barriers to
implementation
• Provide
performance
feedback to staff,
management, and
stakeholders
Stages/Activities
Full
Implementation
•Apply lessons
learned from initial
implementation to
full operation
•Track fidelity
through quality
assurance and
performance
evaluation data
•Solicit feedback
from multiple
stakeholders and
consumers
•Evaluate impact on
child and family
outcomes
Innovation
Sustainability
• Adapt or adjust
intervention model
to reflect lessons
learned from
stakeholder
feedback, tracking,
evaluation
• Communicate
changes and
rationale
• Re-build
competency
around modified
model
• Establish long term
funding sources
• Align ongoing
quality assurance
and performance
measurement with
model
• Promote visibility
of new practice
and successful
outcomes
National Implementation Research Network:
Implementation Drivers
Performance Assessment
(Fidelity)
Systems Intervention
Coaching
Facilitative Administration
Training
Selection
Integrated
&
Compensatory
Decision Support
Data System
LEADERSHIP
© Fixsen & Blase, 2008
Process for Implementing Change
Change Management Model
Awareness of the need for change
Desire to participate and support the
change
Knowledge of how to change
Ability to implement the required
skills/behaviors
Reinforcement to sustain the change

Experiences in Implementing
Change
WV SAMS: The Case for Change
West
Virginia performed below national
standards on Safety Outcomes in the last two
federal Child and Family Services Reviews.
A
child in West Virginia is three times more
likely to have an open Child Protective Services
case than the national average.
West
Virginia needs to refocus CPS practice
and center services on children and families.
WV SAMS: Project Overview

A comprehensive CPS assessment process from initial intake to
case closure, and a more precise way to determine safety and
respond to unsafe children.
Based on what is considered to be the current national cuttingedge model for Child Protective Services.
Will improve West Virginia’s safety outcomes for children and
families by:

focusing services more on safety;
focusing on the protective capacities of caregivers;
improving family engagement.
Major Project Building Blocks or
Conceptual Framework
SAMS PHILOSOPHICAL PRINCIPLES:
Child safety is paramount.
Permanency is an integral part of safety.
Rights of children and caregivers.
Respect for families.
Child-centered and family-focused practice.
Least intrusive intervention.
Drivers of Change in WV

Leadership-Commissioner, Deputy
Commissioners
Organizational-Steering/Implementation
Teams/Project Leader/Coordinator, ACCWIC
Consultants
Competency-Training Division, Special Forces,
Action CPS Consultants
ALASKA CHILD WELFARE
DISPROPORTIONALITY
REDUCTION PROJECT
The Case for Change

While the Alaska Native population is 15.2% of the
state population, 62% of all children in out of home
placement in AK are native.
Over 250 Alaska Native villages are located across
huge geographical area twice the size of Texas.
There are fundamental differences in legal opinions
between state and tribal governments regarding
the scope of authority, including matters of child
welfare.
Drivers for Change

AK’s performance on 1st and 2nd round of CFSRs
identified problems with safety and permanency
outcomes for all children, as well as concern for overrepresentation of Native children.
Recent settlement of the Alaska Superior Court Curyung
Decision requires Office of Children’s Services to
engage in improved ICWA compliance practice.
While Alaska tribal partners have attempted to
address issues over past 30 years, these drivers have
renewed support from the Office of Children’s Services
and the Court Improvement Project.
Goals of the Alaska Implementation
Project
Strengthen
cultural competence
Enhance interagency collaboration and state-tribal
relations
Implement family centered, state tribal alternative
response system
Promote tribal participation in decision making and
services
Enhance tribal resource family development
Prevent out of home placements when possible
First Steps in Implementation….

Attend to the organizational and systemic factors:
Name
and address historical trauma
Build trust through shared commitment
Improve communication through honest dialogue
“Courageous Conversations”
Strengthen leadership capacity
Promote action despite political environment
Bring hope for change (Hawaii Differential Response
Model)
Competencies for Leading Change
Creativity
and innovation
External awareness
Flexibility
Strategic Thinking
Vision
Multilevel Influences on Successful
Implementation
Child/Family and
Worker/Practice
Organization/Management Factors
Systemic Factors
Reflections – Leading and
Implementing Change
What role do staff play at different levels of the
organization in leading change efforts?
How can staff be best prepared to take on a new
change effort in the organization?
What strategies has your organization utilized to
prepare the organization for upcoming practice
change?
Lessons Learned
Maria Scannapieco
Mountains and Plains Child Welfare
Successful, sustained implementation
isn’t easy!

Leadership
Trusting relationships
Flexibility vs. staying the course
Champions
Time and resources
Communication, communication, communication
Defining roles and responsibilities
Readiness and reality
Measures of success
Capacity building
Who owns the plan?
Lessons Learned with Tribes

Different issues of trust
Understanding of implementation science
Building capacity and access to technology
Each Tribe has unique identify with different
languages, customs and traditions
Layers of complexity
Rural insular communities
Tribal politics
Key Elements of Systems Change
Final Thoughts

Sharing your lessons learned in implementing
Fostering Connections and other change efforts in
child welfare:
What
have been your experiences?
What drivers have you found most important?
Are there things you would do differently?