region x innovation grant · 2 learn –workforce home visiting study guide – new reflective...

REGION X INNOVATION GRANT

EVALUATION FINDINGS

OVERVIEW REGION X GRANT

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Learn –Workforce Home Visiting Study

Guide – New reflective supervision guidelines and supports

Grant Aim: increase capacity of home visiting organizations, supervisors and home visitors to better meet the diverse and complex needs of families in Region X.

Build – Training/coaching innovations

NEAR@HOME trainings

FAN trainings

Design workshops

Evaluate – quality and efficacy of training/coaching innovations

PRESENTATION OVERVIEW

What We Did Evaluation Goals What We Learned about: FAN NEAR@Home Big Three Design Workshops Home Visitor’s Reasons for Leaving

Positions What it Means

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GRATITUDE

Thank you to our many Region X partners:

WA DCYF: Laura Alfani and Nina Evers, Governance Committee, Evaluation Committee, & other sub-committees and working groups

Home visiting agencies & staff

Butler Institute for Families & other Region X stakeholders

Innovation partners:

Big 3 Design Workshops: Tori Leonard, facilitators, Anthro-Tech Inc.: staff

FAN; Linda Gilkerson, FAN trainers, Erikson Institute, Cooper House staff

NEAR@Home: Quen Zorrah, NEAR@Home State facilitators, THRIVE4

EVALUATION GOALS: WHAT WE SET OUT TO DO

Conduct Implementation & Outcome Evaluation That Would… Meet the Region X Workforce Innovations (FAN, NEAR, Big 3)

“where they are” - in their various levels of development Understand the innovations & collaborate on methodology Document participants’ experience & outcomes Provide useful, timely feedback to trainers & states Improve future training experiences & efficacy

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WHAT WE MEASURED: INFLUENCING FACTORS & KEY OUTCOMES

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Initial Participant Reactions & Experience

Short Term Outcomes:Knowledge,

Skills, Attitudes

Longer Term Benefits:

Well-Being, Support, Retention

Home Visitor Factors

Home Visiting Program Factors

Organizational Factors

Qualitative Interviews Several Time Points

46 Participants

• Home Visitor + Supervisor Dyads• Trainers/Facilitators• Model Developers• Governance Committee/

Stakeholders7

Quantitative Surveys 3 Time Points

(Pre & Immediate Post Training, 4-6 Month Follow Up)

A Majority of Training Participants Completed Measures at Both

Pre Training & Follow-up

EVALUATION DATA SOURCES FAN & NEAR@Home

FACILITATING ATTUNED INTERACTIONS (FAN)

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What is FAN? A Reflective Approach for Supporting Family Engagement & Reflective Practice

• Builds Mindful Self Awareness & Attuned Interactions Between:

• Supervisors & Home Visitors• Home Visitors & Families• Families & Children

18 Programs Trained & Supported• 2-day Face to Face Training• 6 Months Mentoring & Supports• 1 Day Face to Face at 6 Months

FAN EVALUATION166 Home Visitors & Supervisors Participated

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WHAT DID WE LEARN?

Implementation Study

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Trainings were:

High quality & engaging

Successful in building FAN understanding

“Team” approach was helpful:

Created shared learning, support, & problem solving

Facilitated broader organizational support – whole team “on board”

Completing FAN Tools for self-assessment, monitoring implementation was essential, although not without challenges -- and changes along the way helped reduce burden 11

FAN IMPLEMENTATION FINDINGS

Focus on shifting the role of the home visitor from one of “fixer” to one of “empathetic listener”

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Sometimes you need to pause and step back and think what is best for the family, not just me ‘fixing it’ but building their capacity. To me, [the FAN approach] takes the pressure off, and I think that would avoid burnout because it makes me feel less overwhelmed or responsible. -Home Visitor


Most Helpful Aspects of FAN Strategies

Flexible approach “meeting families where they are.”

Teaching mindful self-regulation skills,

Providing a frame for the visit with ARC questions (beginning, middle, end)

Helping to center the visit on the parent’s experience of being a parent.

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Most Helpful Aspects of FAN Strategies

FAN has changed my work life altogether because it’s a way to organize what you do and a way to reflect on what you are doing…the FAN becomes a part of you and who you are and what you do all the time. -Supervisor

For home visiting staff:

Follow up mentoring support – 6 months of coaching after training

Having even more "touch points” for retraining & support to sustain progress would be of value

For ‘train the trainer’ model:

Strong and regular contact & support from master trainers.

Master trainers observing trainings & immediate feedback. 14


What Supported Successful Implementation?

Better FAN Implementation When Organizations:

Already use & value reflection & reflective supervision

Understand “up front” time & expectations for FAN

Help to integrate FAN concepts with home visiting model

Flexibility around home visiting model requirements. 15


Organizational Context Matters

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Enhancements to Training Suggested

More time for role plays & practice using FAN at in person training.

Be clear about expectations for time & completing FAN tools at the start

Use training time to introduce & discuss tools with home visiting staff

Provide additional supervisor & team time with FAN trainers during Mentoring Phase

WHAT DID WE LEARN?

FAN Outcome Study

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Specific FAN Skills – (active listening, self-awareness, following parents’ leads, etc.) Improved Over Time, Especially for Specific Subgroups (Bachelor’s Degrees, White/Caucasian, NFP)

FAN OUTCOME FINDINGS

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FAN OUTCOME FINDINGS

Significant Increases in Staff Emotional Regulation Skills Over Time

Significant Increases in perceived Organizational Support Over Time

No Overall Improvements in Work Stress or Burnout, but - For some subgroups associations were found: Staff with lower emotional regulation showed reduced job burnout over

time Staff receiving more reflective supervision at start had more

improvements in work self-efficacy at follow up

QUESTIONS?

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STEPS FOR LEARNING

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What is NEAR@Home? Builds capacity for addressing trauma with families using NEAR@Home Toolkit to:

Increase brain science knowledge,Understand adverse childhood experiences (ACEs), &Learn strategies for partnering with family’s to strengthen resiliency

Training & Supports to 24 Programs Including:Step 1: Exploratory Readiness ConversationStep 2: 2 Hour Foundational Science Webinar Step 3: 1 day, Facilitated In-person LearningStep 4: 4 Months of Integration Supports

NEAR@Home EVALUATION115 Home Visitors & Supervisors Participated

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WHAT DID WE LEARN?

Implementation Study

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Staff Positive About Learnings:

Learnings were well organized

Questions & concerns were heard & respected

NEAR@Home facilitators were responsive to concerns

Most Valued About Learnings: Practice scripts, conversations & peer learning Completing the ACEs questionnaire for themselves

NEAR@HOME IMPLEMENTATION FINDINGS

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Flexibility to wait for the right time to attempt a NEAR visit (for staff and families).

Supportive supervision time (focus on reflection, talking about ACEs, or NEAR visit activity).

Ongoing support, calls & contact with NEAR@Home facilitators.


Most Valued Aspects of NEAR@Home Approach

Implementation was supported when: Organization/program valued the approach

Regular, structured reflective supervision practice in place

Programmatic focus on ACEs and/or trauma informed practice

Staff prior training for ACEs and/or trauma-informed practice

Programs Had strong strengths-based approach to working with families

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NEAR@Home Stimulated Self-Reflection & Understanding

NEAR@Home helps you understand the whole concept of how ACEs affect you. It gives you an opportunity to reflect on your own life and understand maybe that's why I reacted that way or made that decision because of something that I experienced in my own childhood. So I think it's...a good tool to be able to reflect on your own life ...Then that helps you understand your client and perhaps decisions that they've been making too. -Home Visitor

Participants had some challenges in implementation: Supervisors worried about how to best support staff

Staff needed guidance to integrate NEAR@Home into their work

Concerns expressed about: Staff comfort in having sensitive conversations

using ‘therapeutic’ language outside the scope of their role

Model Developer & Facilitators made changes along the way and saw concerns decrease over time as staff became familiar with the approach. 28


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Suggestions for Learning Steps: Revise some/translate all

materials Increase interactive activities Incorporate more supported,

NEAR@Home visit practice time Increase shared learning

(community of practice) & support time (facilitator with teams)


Areas for Enhancement

Suggestions for Facilitator Training: Ensure facilitators are familiar with

home visiting model/curriculum Provide more individual, one-on-

one support (supervision calls for facilitators)

Add observation opportunities (model co-developer/experienced NEAR facilitators)

WHAT DID WE LEARN?

Exploratory Outcome Assessment

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Home visiting staff benefits:

Staff better understand their own behavior

Builds trust & quality of support

Better identify family needs/referrals

Increased empathy

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NEAR@HOME EVALUATION

Outcome Findings

Benefits for families:

Supports parental stress management

Increases parents’ reflective skills & awareness processes

Guides parents toward hope & resilience

Now I really understand how it [NEAR@Home] can help people, empower them with knowing, and help them overcome and break the cycles. ~Home Visitor

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NEAR@Home - Specific Skills (initiating conversations about ACES with families, understanding ACES effects on behavior, etc.) Improved Over Time (trend), especially for subgroups (Bachelor’s Degrees, NFP)

NEAR@HOME EXPLORATORY OUTCOME FINDINGS Skill Improvements Emerged

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Compared to those receiving high reflective supervision at the start, those who started out with less reflective supervision were more likely to improve:

Decreased burnout at follow up (n=27)

Increased self efficacy at follow up (trend; n=30)

NEAR@HOME EXPLORATORY OUTCOME FINDINGS Subgroup Benefits Warrant Further Study

QUESTIONS?

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Reflecting on Cultural Responsiveness for FAN & NEAR@Home

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Staff noted that some traditional cultural values need to be considered with FAN/NEAR approaches: Norms related to expressing emotions, Openness to sharing with professionals, those outside

their cultural group, and Differing parenting practices and values.

“Latino families are very sensitive right now because of the immigration situation…You have to build trust with them first.... [The approach] asks sensitive questions, and many families...They’re afraid.... And I’m afraid as a home visitor to…trigger, and upset them, and break their trust.” -Home Visitor

Participants Suggested:

Hire/train more bilingual/bicultural trainers and facilitators

Provide supplemental materials, resources, & activities in more languages

Engage in cultural exploration as “advance work” prior to working in communities

Attend to variability in cultural norms for discussing sensitive & personal issues

Stakeholders Added:

Gather more information about adaptations needed from culturally and linguistically diverse staff and family members – participants in this study mostly White

Recognize that best practice suggests that culturally responsive strategies need to go beyond individualization and build on specific cultural strengths

Reflecting on Cultural Responsiveness Ideas Were Shared for Future Work in Cultural Adaptation

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“BIG 3” DESIGN WORKSHOPS

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Used “Human Centered Design” approach to engage home visiting workforce in co-creating strategies to help address “the Big 3”:

1. Substance Abuse2. Mental Health Concerns3. Family/Intimate Partner/

Domestic Violence

EVALUATING BIG 3 DESIGN WORKSHOPS

Evaluation Questions

1. What was it like to be part of the human-centered design process for home visiting staff?

2. How does being engaged in the design process influence beliefs about usefulness of new ideas and motivation to implement these ideas?

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1 Design Workshop per State

Almost 50 Participants:Home VisitorsSupervisors

Content ExpertsOther key staff

BIG 3 DESIGN WORKSHOPS EVALUATION FINDINGS

Home visiting staff were extremely positive about their Design Workshop experience:

Felt valued for knowledge and expertise

Appreciated the opportunity to think creatively about challenging issues

Facilitators were key to engaging participants in the design process.

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BIG 3 DESIGN WORKSHOPS EVALUATION FINDINGS

Staff brought ideas back to their workplace for

Improving self-care Creating a more trauma-informed workplace Designing more effective data systems &

technology (or phone apps) to maintain up-to-date resources

Participants hope ideas move forward, and will not be “put on the shelf”

Staff want to learn more about how to address the impact of Big 3 trauma on children. 40

BIG 3 DESIGN WORKSHOPSNEXT STEPS

Build on ideas and discussions generated by continuing the human-centered design process.

Develop a prototype (draft) solution based on ideas from the workshops.

Collaborate with home visiting staff to improve the prototype and make recommendations for further developing and sustaining the solution. 41

“It’s empowering for [home visitors] to be

creating ideas that are eventually for their

benefit”– State stakeholder

EXIT INTERVIEWS What We Heard from 12 Home Visitors

What Would Help Them Stay? More time for shared & peer learning

Professional recognition from organizations

Increased organizational & programmatic flexibility

Better pay & opportunities for advancement

Clarity & understanding of job expectations when hired 42

Why Did Staff Leave Their Positions? Increased paperwork demands,

emphasis on meeting program quotas (“the numbers”)

Low supervisory & administrative and/or organizational support

Lack of job flexibility & advancement opportunities

Moving Forward: Continuing to Support the Home Visiting Workforce in Region X

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Key Recommendations

SUSTAIN - Sustain practice changes with additional follow up with trainers/facilitators, communities of practice

EXPAND - Create opportunities for more programs to be trained – capitalize on investment in state/regional trainers & facilitators

IMPROVE – Use findings to improve future training and learnings for FAN and NEAR

ADAPT – Do more work to improve cultural responsiveness and engage more diverse trainers, learning from diverse families & staff

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COMMENTS&

QUESTIONS

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Region X Innovation Grant:

Email: [email protected]

Website: www.dcyf.wa.gov/services/child-dev-support-providers/home-visiting/innovation-grant

Region X Evaluation:

Email: [email protected]

https://www.pdx.edu/ccf/completed-research-projects

Big 3 Design Workshops:

Email: Tori Leonard, [email protected]

Website: https://anthro-tech.com

For More Information & Contact

Facilitating Attuned Interactions:

Email: Linda Gilkerson, [email protected]

Website: https://www.erikson.edu/professional-development/facilitating-attuned-interactions/

NEAR@Home:

Email: Quen Zorrah, [email protected]

Website: https://www.nearathome.org

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