implementing family-centered, strengths-based, and...

Implementing Family-Centered, Strengths-Based, and Safety-Organized Approaches in Child Welfare Practice: Reflections and Recommendations

August 2013

© 2013 by NCCD, All Rights Reserved https://sharepoint.nccdcrc.org/Projects/Project Documents/USA/California/808 San Diego PF/Full SOP Implementation Plan.doc

TABLE OF CONTENTS

I. Introduction ................................................................................................................................................................. 1 II. Background .................................................................................................................................................................. 2 III. Overall Implementation Considerations ........................................................................................................... 3

A. Leadership .................................................................................................................................................... 3 B. Participation ................................................................................................................................................. 4 C. Co-Development ........................................................................................................................................ 4 D. Strategies for Change ............................................................................................................................... 4 E. Strategies for Change: Infrastructure .................................................................................................. 5 F. Rigor ................................................................................................................................................................ 6

IV. Implementing Safety-Organized Practice in California ................................................................................ 6

A. Overview of Two- to Four-Year Implementation Process ........................................................... 8 B. Overview of Pre-Implementation ......................................................................................................... 9 C. Pre-Implementation ............................................................................................................................... 10 D. Overview of Implementation .............................................................................................................. 13 E. Implementation ....................................................................................................................................... 14 F. Overview of Self-Sustainability .......................................................................................................... 17 G. Self-Sustainability.................................................................................................................................... 18

V. Conclusion ................................................................................................................................................................. 20 References/Resources ........................................................................................................................................................... 21

1 © 2013 by NCCD, All Rights Reserved https://sharepoint.nccdcrc.org/Projects/Project Documents/USA/California/808 San Diego PF/Full SOP Implementation Plan.doc

I. INTRODUCTION

Child welfare organizations across the world have expressed a growing interest in finding ways to

integrate and implement family-centered, strength-based, and safety-organized approaches within

child welfare casework. This work—drawn from the best practices learned across the world and from

innovators in the child welfare and family-centered practice field such as Insoo Kim Berg, Steve de

Shazer, Susie Essex, Sue Lohrbach, Rob Sawyer, Andrew Turnell, Nicki Weld, and Michael White—can

include:

x Strategies for engaging birth families that lead to meaningful participation in the child

welfare process;

x Practices for keeping children and their voices a central part of the work;

x A consistent assessment and planning framework that can be used with families and within the organization as way to organize and analyze information;

x A structure for regular group supervision and consultation;

x Family-centered techniques and practices for having detailed conversations with families regarding agency concerns and goals;

x Practices for approaching dialogue about permanency with families;

x Approaches to working with and across cultural differences that bring a practice of inquiry and curiosity to our work with others; and

x Connections with other child welfare innovations such as the Structured Decision Making® (SDM) system, family team meetings, Differential Response, and more.

While these approaches have been available and in the field for some time, rarely have they

been implemented effectively and with fidelity on a large scale, integrated with agency infrastructure,

and sustained.

This document attempts to bring together ideas, reflections, and recommendations for

implementation these approaches. The NCCD Children’s Research Center (CRC) has gathered this


information from research and with our partner jurisdictions1 as we have begun this work. It is meant

to be a working document and likely will be updated by CRC as new lessons are learned.

Bringing these practices fully into an organization is not easy and requires a significant

commitment of time and resources. However, clear pathways for success and sustainability are

apparent. At a time when millions of dollars are spent nationally on training and implementation of

best practices and evidence-based approaches, it is critically important for organizations to proceed

thoughtfully and with clear plans that draw on the best of what is known to work well.

We hope this document provides assistance in this—that it provokes good questions and

conversations among key stakeholders and helps child welfare jurisdictions in seeing a path toward

implementation of this important work.

II. BACKGROUND

For more than 20 years, CRC has supported SDM® system implementation in national and

international child welfare agencies. The SDM system includes a series of evidence-based assessments

used at key points in child protection casework to support staff in making consistent, accurate, and

equitable decisions throughout the life of their work with a family. Additionally, the SDM system

allows an organization to better understand its data, better manage limited resources, and better

direct resources to families most in need.

In recent years CRC has begun integrating contemporary, family-centered, strength- and

safety-organized social work practices alongside the SDM assessments, allowing an evidence-based

decision-support system to be tied with rigorous, culturally responsive clinical practices to support

better outcomes for children and families. While this integrated approach is relatively new in the

United States, early adopter jurisdictions such as Olmsted County, Minnesota; San Diego County,

1 CRC would like to particularly thank staff and leadership in child welfare organizations in the County of San Diego, CA; The Province of Manitoba, Canada, the State of Colorado, the Northern California Training Academy and the Massachusetts Child Welfare Institute for being our partners in this work


California; the State of Massachusetts; and the province of Manitoba, Canada, have seen benefits to

this integration of assessment use and strengthened social work practice.

To support this approach, CRC has developed curriculum, training, and coaching help for

strengthening social work practices, enhancing organizational infrastructure, and linking those to the

SDM system. This integrated approach serves to strengthen social work skills, make SDM assessments

relevant, and integrate the wisdom of traditionally marginalized cultural groups; and allows

jurisdictions to meet their goals of safety, permanency, and child well-being.

III. OVERALL IMPLEMENTATION CONSIDERATIONS

CRC and the social work field as a whole have learned a great deal over the last 20 years about

how to best support uptake of new and innovative practices in human service organizations and what

can derail even the best practices from full implementation. The following factors should be

considered by organizations intending to implement these practices.

A. Leadership

Child welfare organizations implementing these practices should create an implementation

steering committee of up to 15–20 leaders from across the jurisdiction, with strong representation

from any local indigenous partner agencies. This group will develop understanding of the full scope of

practices being implemented, help develop strategies for implementation, make recommendations to

management regarding timing and staff selection for subgroups, and serve as overall ambassadors for

this change to their peers and the rest of the organization. Former consumers (youth and families)

should be strongly considered for membership on this team as well.


B. Participation

CRC also suggests the identification of “early adopters” for many of the strategies described

below. Early adopters are staff who are likely to be the most excited about receiving training and

coaching. They are a group of diverse staff from across the organization—individuals often held in

some esteem by their peers—who could potentially become trainers, coaches, or leaders of this

practice shift. Ultimately, these early adopters often become the biggest champions of the practice

and have the biggest influence on their peers.

C. Co-Development

Many jurisdictions come to this work with existing practice models, experience, and training

materials already developed on family-centered approaches, etc. When CRC is involved we also come

with experiences in helping other jurisdictions integrate the SDM system with enhanced family-

centered social work practices. These materials and approaches provide a critically important starting

place and in our experience it is important that this work be adapted and adjusted as the

implementation plan is created. This should be accomplished through a series of facilitated

workgroup sessions with both the steering committee and other key stakeholders across the

organization.

D. Strategies for Change

A critical element for any successful implementation is the understanding that training alone

is not sufficient for implementation—training and implementation should not be confused as the

same activity. Training is an important component of any implementation, but for any meaningful

change to occur in organizational practice, regular coaching should be included as well. Coaching

refers to regular practice, observation, and feedback sessions with small groups, held at local and/or


regional offices, by someone with dedicated time to help increase staff understanding of a new

approach, usually as they are going through training.

E. Strategies for Change: Infrastructure

Infrastructure here refers to the daily processes within the organization (such as supervision

and family meetings) that need to be aligned and congruent with the new practices in order for any

real uptake of the practices to occur. This may include changes to policy, procedure, and practice.

Some infrastructure enhancements that organizations should consider include:

x RED Teams. The Review, Evaluate, and Direct (RED) process pioneered by Sue

Lohrbach and Rob Sawyer in Olmsted County, Minnesota, is a group decision-making process that occurs at screening and brings the best of group critical thinking to the work of screening and response. It involves a daily meeting of workers and supervisors from different parts of a particular office to organize and consider the information obtained at screening; apply clinical, statute, and policy analysis; and make a decision about a department response category. This can be used in conjunction with the SDM hotline tool and serves as a foundation for teamwork, critical thinking, and ongoing learning throughout the rest of the case process.

x Regular Group Supervision and Consultation With a Consistent Assessment and

Planning Framework. Group supervision involves pulling together members from across a particular office for regular case consultations at critical points. This process serves both as a way to help inform case direction and as an ongoing learning vehicle for making practice and integration with the SDM system relevant. A successful implementation of an integrated approach to family-centered social work practices with the SDM system often is significantly enhanced by regular, ongoing group supervision across the agency.

x Enhanced Family Meetings Structures and Facilitation. Family meetings create

avenues for family and network participation at all points in the casework process. CRC has found that increasing these opportunities for family participation by enhancing facilitation skills and ensuring the availability of multiple kinds of structures for the different meeting purposes more fully embeds the new integrated practices across the organization.


x Alignment With Local SACWIS Systems. SACWIS systems inevitably drive practice. Choices available in text fields and dropdown menus shape practice and reinforce what the organization considers important. As any practice enhancements are made, conversations should occur concurrently on what changes, if any, can be made to the local SACWIS system to support these changes or how to best embed the practice in the current system.

F. Rigor

Finally, the use of pre- and post-implementation evaluation is highly recommended to

accompany this process. CRC sees evaluation as a critical driver in successful implementation.

Evaluation allows child welfare organizations to determine if the new practices are being

implemented with quality and fidelity, what effect they are having on the quality and completion of

existing assessments, and what ultimate effect they have on agency outcomes.

A number of these ideas and strategies are embedded within the detailed implementation

plan below.

IV. IMPLEMENTING SAFETY-ORGANIZED PRACTICE IN CALIFORNIA

The following overview of a suggested implementation plan is one CRC has used to help

partner with jurisdictions implementing these enhanced social work practices with the SDM system.

This process serves to 1) enhance its existing SDM system practice and 2) add accompanying family-

centered social work practices to help make the system relevant to direct work with families. In

California, these enhanced practices are brought together under the umbrella term of safety-

organized practice (SOP); thus that term is used to describe these enhanced practices in the following

materials.

It is important to note that this implementation plan should serve as an outline only—any

implementation plan should be adapted by the appropriate jurisdiction with a representative


implementation team to ensure it will be successful in the local contexts and with local families and

cultures.

CRC has found a three-step process helpful in designing an implementation strategy for this

work: A pre-implementation foundational period of learning, development, and testing; an

implementation period when new practices become diffused, trained, and codified across the

organization; and a sustainability period when the organization begins to replicate the process for

new staff and incorporates the approach in all of its regular policy, practice, and training.

This approach to implementation relies minimally on “stand-and-deliver” training conducted

by outside experts and relies most upon the diffusion of the practice through peer-to-peer training

and coaching as a primary vehicle for change. In essence, the approach proposed here is to “grow” the

implementation rather than “launch” it, doing it “with” the workers, supervisors, organizations, and

community rather than “to” them. This approach fosters a greater sense of collaboration and

accountability as the process unfolds. This process is outlined below.


A. Overview of Two- to Four-Year Implementation Process

6–9 months 12–18 months 6–9 months


B. Overview of Pre-Implementation


C. Pre-Implementation What? A six- to nine-month period of “voluntary adoption” of safety-organized practice (SOP) focused on:

x Provision of initial overview of SOP/SDM system integration to key stakeholders by NCCD CRC staff;

x Identification of early adopters/networks interested in trying out the practices;

x Initial dissemination of SOP practices;

x Early, rigorous tests of change (plan do study acts [PDSA]);

x Identification of areas of easy/difficult integration with SDM system;

x Revision or development of particular policies needed to support the practice;

x Development of communication plans to key internal/external stakeholders;

x Provision of three- to five-day Training for Trainers (TFT) for key staff (some combination of training academy and local office staff);

x Development of staff enthusiasm and motivation for change; and

x Identification of the particular elements of SOP jurisdiction wants to fully commit to.

Why?

x Lays a foundation of staff support through a period of “voluntary” adoption within the organization, which helps to minimize resistance later;

x Helps to make clear the portions of the practice that need unique adaptation; and x Minimizes the degree of change that occurs later. x “Sometimes you have to start slow to go fast.” (Bill Madsen)


How? Potential Activities During Pre-Implementation Admin and policy staff:

x Identify and recruit agency leadership team to support implementation (the learning team);

x Identify policy/paperwork/IT issues that will need to be addressed in implementation;

x Create a communication plan to introduce SOP/SDM system integration to key internal (admin staff, union leadership, citizen boards, etc.) and external (legislators, citizen groups, sub-contracting providers, other community partners) stakeholders, and identify any particular training/orientation needs for these groups;

x Identify small group of internal and external coaches (depending on size of jurisdiction) available to support implementation;

x Identify group of former consumers (parents and alumni youth) available to help

support implementation; and

x Develop both formative (early) and outcome evaluation plans with benchmarks (potentially with external consultants).

Learning team and other frontline staff:

x Identify other early adopters and existing groups/networks (like the SDM trainers); x Begin early spread of SOP through required trainings and voluntary use of tools and

strategies, supervision, case consults x Implement “tests” of SOP practices through PDSAs/small acts of change projects with

simple ways to look at outcomes; x Work to identify the specific components of SOP that mesh easily with SDM, those that

do not, and what can be done about it; and x Work to identify the specific components of SOP that mesh easily with existing county

policies and practices, IT, etc., and those that do not. External trainers:

x Provide initial half-day overview of SOP/SDM system integration to key stakeholders and agency leadership;


x Develop curriculum materials and trainer manuals for a) a one-day orientation to SOP/SDM integration training for all staff, b) a five-day TFT, and c) a three-day advanced TFT follow-up;

x Provide a five-day TFT for key personnel, including those likely to serve as coaches in

the future;

» Note: Attending these sessions would also be some former consumers who will play a role in the future training.

x Provide ongoing web and phone support to admin/policy, members of the learning

team, and future local coaches; and x Co-design and facilitate a one- to two-day best practices gathering that will bring

together early adopters to review results of pre-implementation, analyze results of PDSAs, and consider how this informs next steps in implementation.


D. Overview of Implementation


E. Implementation What? A 12- to 18-month period of standardization and implementation of required SOP/SDM practices that includes:

x Single-day orientation sessions for all staff, ideally delivered by one internal county coach, one former consumer, and potentially one external trainer (for large jurisdiction may need to offer multiple sessions). Content to include both overview of SOP/SDM system and any policy/practice changes required;

x Phased rollout of different SOP components with clear benchmarks and expectations for the jurisdiction;

x Development of local implementation teams in each regional office consisting of early

adopters/learning team members from those offices to support implementation;

x Regular, ongoing training and coaching with small groups in the regional offices (keep groups under 50 and plan for make up sessions);

x Feedback loops for quick formative evaluation(s) of rollout and what may need to be

changed/adapted;

x Ongoing phone/web support with external trainers;

x Formal three-day TFT follow-up (keep groups no larger than 50); and

x Data collection for formal evaluation. Why?

x It is important to have a clear road map for achieving standardization and implementation across the region in a way that offers local teams a sense of empowerment and ownership over the process.

x “The heart of the diffusion process consists of modeling and imitation by potential adopters of their network partners who have already adopted.” (Everett Rogers)


How? Potential Activities During Implementation Admin and policy staff:

x Provide clear policy guidance, and communicate to staff what SOP elements are to be a regular part of practice;

x Finalize policy decisions and ensure consistent practice language throughout all

policies and practice guidance in SACWIS system; x Create policy or practice guidance and documents as dilemmas/needs emerge;

x Conduct regular communication and semi-regular meetings with learning team and

coaches to receive feedback on rollout; x Support new local office implementation teams as they work to support regional

office implementation; x Continue data gathering for formal evaluation; and

x Monitor benchmarks established and look for early signs of success or barriers.

Learning team and frontline staff:

x Begin/continue to implement selected SOP/SDM practices;

x Identify key leaders and help form implementation teams at the regional offices to identify particular constraints and partner with coaches to best support implementation (implementation teams should consist of regional office early adopters, but should also include someone from the management team in the office and a former consumer also);

x Partner with coach on design and delivery of coaching content for regional office (see below); and

x Provide feedback/reports to admin and policy staff on specific areas of implementation on a regular basis.

Coaches:

x Provide, with former consumer(s), a one-day orientation session to all staff (potentially also with external trainer);


x Provide regular, ongoing small group coaching sessions with all staff. The coach, regional office management staff, and implementation team will develop topic areas for these coaching sessions;

x Use coaching sessions for a variety of purposes as the year goes on including: » Follow-up of large-scale staff orientations to answer questions;

» Delivery of follow-up trainings on particular topic areas (e.g., interviewing

children, solution-focused interviewing); and

» Safety mapping consultation sessions for individual cases.

x Provide feedback/reports to admin and policy staff on specific areas of implementation on a regular basis.

External trainers:

x If needed, co-facilitate initial orientation sessions for staff with coaches and consumers;

x Continue to provide phone and web-based support and consultation to coaches and key personnel in implementation (start weekly for initial time, then bi-weekly, and ultimately monthly for remainder);

x Update all curriculum material to reflect the agreed-upon standardized practice based

on learning from pre-implementation phase and decisions made by county;

x Provide three-day advanced TFT to selected coaches and any other key personnel;

x If needed, provide second TFT to increase number of local personnel with deep understanding of the model;

x Conduct the Facilitative Supervisor one-day training and roll out cross-

regional/functional Learning Circles (for each group – supervisors, managers, social workers) with local training academy staff; and

x Introduce group supervision model to reinforce the SOP team decision-making

concepts.

x Modeling Family Team Meeting facilitation for local coaches and facilitators.


F. Overview of Self-Sustainability


G. Self-Sustainability What? A six- to nine-month period of stabilizing final adoption of combined SOP/SDM practices focused on:

x Continuing the promotion of new practices to others;

x Identifying any key outliers not reached and developing plans to reach them;

x Expecting and identifying areas of likely backsliding;

x Identifying traditional places where practices tend to become siloed and paternalistic, e.g., staffing consultation before switching workers, “warm hand-off” practices, etc.

x Watching infrastructure needs and making any changes, e.g., staff re-deployment, as

case assignment and workload landscape begins to shift;

x Incorporating SOP practices to the point where they are seen as regular organizational activities and not specialized; and

x Gathering up the learning from this experience to share with other counties, states,

and jurisdictions undergoing similar change. Why?

x After the initial push, innovations in organizations can be hard to routinize and do not necessarily continue. It is fair to expect a certain amount of backsliding. It is important to uphold a process for building on what is working well, address problems as needed, and maintain the adoption.

x “One important factor in explaining the degree to which in an innovation is sustained by an organization is participation … if many of the organization’s members have participated in the designing, discussing, and implementing of an innovation, it’s sustainability over time is more likely.” (Everett Rogers)


How? Potential Activities During Self-Sustainability Admin and policy staff:

x Begin to share early returns from the evaluation with both internal and external stakeholders;

x Address (or target plan for addressing) any large-scale barriers that continue to impede implementation (e.g., any changes needed in IT down the line); and

x Devise final incentives (positive and negative) that may be needed to reach any late adopters.

Learning team and frontline staff:

x Continue to promote and integrate practices;

x Identify what supports or impedes routinization of the practices;

x Rollout cross-regional/functional Learning Circles; and

x Organize and convene second best practices gathering to support learning, spread, and stabilization of the practices.

Coaches:

x Conduct assessment to identify any remaining training or coaching needs;

x Partner with learning and implementation teams to identify any final impediments to stabilization of the practice; and

x Support the organization of second best practices gathering.

External trainers:

x Continue phone and web support, if needed; and x Develop chart reviews to support the evaluation and reflection on practice, if needed.

For all involved:

x Gather up the learning from this experience to share with other counties, states, and jurisdictions undergoing similar change.


Planning for Costs Over Time

x One-day orientation sessions for key employees (plus half-day planning session with learning team)

x Three-day SOP advanced follow-up x Five-day TFT on the 12 modules x Twelve monthly SOP modules over one year x Ongoing web-based support x Coaching: one coach (per 200 employees max), 20 hours a week x Project management and policy work: two to three employees x Implementation teams (local and centralized)

x Learning Circle roll out for all three levels (supervisors, managers, social workers) x Evaluation x Best practices gathering

V. CONCLUSION

This document outlines a structure in which child welfare jurisdictions can 1) add enhanced

family-centered, strengths-based, and safety-organized social work practices to their work; 2) connect

these to existing innovations such as the SDM system; and 3) sustain this integration in agency

infrastructure, policy, and practice. CRC staff hope this document was helpful; and we look forward to

reflections, feedback, questions, and ideas for deepening this work.


REFERENCES/RESOURCES Berwick, D. (2003). Disseminating innovations in health care. Journal of American Medical Association,

289(15). Bickman, L., Kelley, S. D., Breda, C., Andrade, A. R., & Riemer, M. (2011). Effects of routine feedback to

clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62, 1423–1429.

Collins, M., Amodeo, M., & Clay, C. (2007). Review of the literature on child welfare training: Theory,

practice and research. Report produced for the National Evaluation of Child Welfare Training Grants. Washington: US Department of Health and Human Services, Administration on Children, Youth and Families, Children’s Bureau. Available at http://www.bu.edu/ssw/research/childwelfare/BUSSW_CSReport2.pdf

DePanfilis, D. (1996). Implementing child mistreatment risk assessment systems: Lessons from theory.

Administration in Social Work, 20(2). Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A

synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.

Foldy, E., & Buckley, T. (2010, January). Re-creating street level practice: The role of routines, work

groups and team learning. Journal of Public Administration Research and Theory, 20(1), 23–52. Kirkpatrick, D. L, & Kirkpatrick, J. D. (2005). Transferring learning to behavior: Using the four levels to

improve performance. San Francisco, CA: Berrett-Koehler Publishers. Rogers, E. (2003). Diffusion of innovations, 5th edition. New York, NY: Free Press. Wheatley, M. (2010). Leadership in the age of complexity: From hero to host. Resurgence Magazine,

Winter 2011. Retrieved from http://www.margaretwheatley.com/articles/Leadership-in-Age-of-Complexity.pdf