policies and procedures: issues for implementation, policy and scaling up barbara j. smith, u. of...
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Policies and Procedures: Issues for Implementation, Policy and Scaling
up
Barbara J. Smith, U. of Colorado at Denver and Health Sciences Center
Policy Maker’s Summit
November 17, 2006
Washington, DC
www.challengingbehavior.org
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Research Framework: Direct Services/Indirect Supports
Longitudinal, multi-site study (KIDS)
Research on direct interventions/services: e.g., emotional/social competence, parent-child interaction, PBS and cultural diversity, family-centered interventions, interventions with toddlers, program-wide PBS
Research on indirect supports Personnel Preparation and Utilization Administrative Operations and Policy
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Promotion, Prevention, Intervention Conceptual Framework: The Teaching
Pyramid
Preventive PracticesPreventive Practices
Building Positive RelationshipsBuilding Positive Relationships
Social and Emotional Social and Emotional Learning StrategiesLearning Strategies
Individualized Individualized Intensive Intensive
InterventionsInterventions
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Policy Research: Literature Syntheses, Focus Groups & Surveys
What are the barriers and/or challenges to effective promotion, prevention and intervention services for young children at risk for or who have challenging behavior?
What are policy and administrative strategies/remedies for addressing the challenges or barriers?
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Information Sources
Center for Evidence-based Practice: Young Children with Challenging Behavior Literature syntheses re: systems and
policies Focus groups National survey
National TA Center for Children’s MH Discussion groups, Nat’l. scan and TA
with states
Centers’ collaborative survey of states
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State Agency Leaders: IDEA Part C, ICC and 619; Child Mental Health; Child Welfare; Maternal and Child Health; Health
Local Program Administrators: Head Start, Child Care (including military programs), Public Schools, mental health consultants, home visitors and other TA providers
Family Members: Lists from PACER and FFCMH, parents involved with programs
National Survey
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Focus Groups
619 and Part C Coordinators
Parents (Il., Fl., Co.)
Direct Service Providers (Il., Fl., Co.)
Administrators (Il., Fl., Co.)
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Findings
Categories of barriers/challenges
Knowledge & Skills (including
eligibility)
Finance (including eligibility)
Beliefs and Attitudes
Collaboration/Coordination/System
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Survey and Focus Groups: Challenges
Beliefs & Attitudes
21%
Knowledge & Skills34%
Finance33%
Collaboration & Coordination
12%
National Survey Focus Groups
Beliefs & Attitudes
24%
Knowledge & Skills33%
Finance31%
Collaboration & Coordination
12%
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National Survey: Challenges (Eligibility)
Collaboration & Coordination
12%Beliefs & Attitudes
24%
Knowledge & Skills33%
Finance31%
Knowledge & Skills-240 (Eligibility-17)
Finance-236 (Eligibility-57)
Beliefs & Attitudes-179
Collaboration-90
Eligibility - 24% of Finance
Eligibility - 7%of Knowledge & Skills
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Focus Groups: Challenges (Eligibility)
Finance33%
Knowledge & Skills34%
Attitudes & Beliefs21%
Knowledge/Skills-103 (Eligibility-6)
Finance-100 (Eligibility-26)
Attitudes/Beliefs-65
Collaboration/Coordination-35
Eligibility - 26% of Finance
Eligibility - 6%of Knowledge/Skills
Collaboration & Coordination12%
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Challenge: Knowledge and Skills (workforce development
& support)
Availability & quality of pre-service training
Availability & quality of in-service training, TA, mentoring and other on-going support
Quality of content of training/support: Evidence-based Eligibility Working with families
High turnover rates
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Challenge: Attitudes & Beliefs
Differing philosophies & approaches
Perceptions of children, mental health, social-emotional development and behavior
Perceptions between professionals and parents
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Challenge: Collaboration & Coordination
Lack of coordination of programs, systems
and resources/funding streams
Lack of collaboration among service providers
Poor collaboration between professionals and parents
Lack of integrated practice/services
Failure to reach under-served populations
Lack of leadership/ownership
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Challenge: Finance
Eligibility criteria and requirements (inconsistent across funding sources, do not support
promotion & prevention, do not include child and family, etc.)
Insufficient resources
Limits on blending resources
Insurance, Medicaid and other third party payment restrictions
Low compensation for EC personnel
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Survey & Focus Groups : Strategies/Remedies
Beliefs & Attitudes
31%
Collaboration & Coordination
20%
Finance15%
Knowledge & Skills34%
Attitudes & Beliefs21%
Finance22%
Collaboration & Coordination
16%
Knowledge & Skills
41%
Focus GroupsNational Survey
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Remedies: Knowledge & Skills
Availability of pre-service training in evidence-based practices re: young children’s social-emotional development and behavior
Availability of in-service training, TA, mentoring, and other on-going support in evidence-based practices
Availability of information and models of evidence-based practices, programs and systems
Higher compensation and other workforce supports
Awareness campaigns
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Remedies: Attitudes & Beliefs
Shared training on evidence-based practices among different professions, agencies and with parents
Awareness campaigns about the importance of young children’s social-emotional development, mental health and behavior
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Remedies: Finance
Policies that support blending and coordinating resources
Policies that support promotion & prevention and support reaching children early
Adequate resources for programs and training/TA/on-going, on-site support
Adequate compensation for EC personnel
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Remedies: Collaboration & Coordination
Policies that promote collaboration and coordination, e.g., System of care Wrap around Addressing differing eligibility limits
Skills in collaborating with families and other professionals
Addressing attitudes and beliefs (turf guarding, trust, differing philosophies)
Inclusion of diverse stakeholders
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Conclusions and Next Steps
There are real policy barriers such as eligibility criteria and service limitations associated with funding sources that are incompatible with a promotion, prevention, intervention model.
By far and away, the majority of barriers to delivering effective promotion, prevention, intervention services to children and families is the lack of know-how and support to implement evidence-based practices.
Strategies that promote, scale-up and sustain the everyday use of evidence-based practices, services and programs in the context of a system.
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Creating Supportive EnvironmentsCreating Supportive Environments
Positive Relationships with Children, Families, Positive Relationships with Children, Families, and Colleaguesand Colleagues
Social Emotional Social Emotional Teaching StrategiesTeaching Strategies
Individualized Individualized InterventionsInterventions
Program Wide Adoption
Teacher Training/Implementation
Administrative Supports
Program Philosophy Well defined procedures
Data Based Decision Making Partnerships
with Families
Program Wide Adoption
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VALUES
Family Voice
Child and Family Centered
Relationship Based
Culturally Competent
Infused into Natural Settings and Services
Grounded in Developmental Knowledge
Prepared Workforce
Family
ConsortiumMaximized and
Flexible Funding
Building Blocks
Promotion Prevention Intervention
Supports for Parents and Families
Supports for Other Caregivers
Services for Children and Families
Services and Supports
Outcome
Evaluation
Strategic Planning, Interagency Partnerships
Developed by Roxane Kaufmann, GUCCHD
Early Childhood System of CareFosters the social and emotional well-being of infants, toddlers, preschool-aged children and their
families
Policies and Procedures
Infants, Young Children and Families
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