WHAT DOES IT TAKE? 5 Lessons Learned from Supporting Evidence-based Home Visiting to Prevent Child...
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WHAT DOES IT TAKE? 5 Lessons Learned from Supporting Evidence-based Home Visiting to Prevent Child Maltreatment Virginia Home Visiting Consortium Meeting
WHAT DOES IT TAKE? 5 Lessons Learned from Supporting
Evidence-based Home Visiting to Prevent Child Maltreatment Virginia
Home Visiting Consortium Meeting October 29, 2013 Melissa Lim
Brodowski Office on Child Abuse and Neglect Childrens Bureau, ACYF,
ACF, USDHHS 1
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Arriving at meaningful solutions is an inevitably slow and
difficult process. Nonetheless..better is possible. It does not
take genius. It takes diligence. It takes moral clarity. It takes
ingenuity. And above all, it takes a willingness to try. 2 From
Atul Gawande in Better
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5 Key Lessons Learned 1.Implementation matters. 2.Know your
data. 3.Partnerships are key. 4.Systems trump programs. 5.Embrace
complexity. 3
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Implementation (quality) matters. 4
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Socially Significant Outcomes Effective & Usable
Interventions Effective Implementation Methods Enabling Contexts
Formula for Success 2012 Dean Fixsen and Karen Blase, National
Implementation Research Network
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What is Quality Implementation? Fidelity Adaptation Dosage 6
http://aspe.hhs.gov/hsp/13/KeyIssuesforChildrenYouth/ImportanceofQuality/rb_Quality
Imp.cfm
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Know your data. 7
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Continuous Quality Improvement 8
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What? So what does it mean? Now what will we do? Adaptive
Action Adaptive Action Process Glenda Eoyang, 2009
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For more information, visit: www.supportingebhv.org
www.supportingebhv.org
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Fidelity Domain Study Structural (Implementation fidelity)
Dynamic (Intervention fidelity) Hiring qualified staff/providing
sufficient training and supervision Engaging the target population
Achieving recommended dosage and duration Maintaining caseload
levels Nature of the provider- participant relationship Manner of
service delivery 11
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Fidelity Standards Explicit standards Implicit standards
Efficiency or best practice standard 12
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Caseloads IndicatorMean Standard Deviation Low Score High Score
Mean monthly HV caseload (n = 35 IAs) 13.46.82.124.8 % home
visitors at or below recommended caseload (n = 35 IAs)
90.918.433.3100.0 % home visitors below recommended caseload (n =
35 IAs) 78.331.416.7100.0 Source: EBHV Cross-Site Fidelity
Database, October 1, 2009 through December 31,2010. 13
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Dosage: IndicatorMean Standard Deviation Low Score High Score #
of visits provided/weeks of enrollment for those still enrolled (n
= 27 IAs) 0.50.10.20.8 % of participants who received all of the
intended dosage during first 6 months (n = 27 IAs) 44.224.60.0100.0
% of participants who received at least 80% of intended dosage (n =
27 IAs) 58.124.70.0100.0 Source: EBHV Cross-Site Fidelity Database,
October 1, 2009 through December 31,2010. 14
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Dropoff Points Screened for service needs Referred to HV
programs Enroll in treatment or community services Complete
treatment or community- based program Achieve Positive Outcomes
Payoff 15 National Center on Substance Abuse and Child Welfare
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Partnerships are essential. 16
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Four Levels of Collaboration 17 Sid Gardner, 2011
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Six Features of a High-Quality Collaborative Process 1.It is
inclusive. 2.It treats all stakeholders equally. 3.It is authentic.
4.It focuses on the problem. 5.It has structural integrity. 6.It is
revisable. Darrin Hicks, University of Denver
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Salem, Oregon 19
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Systems trump programs. 20
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EXISTING SYSTEM EFFECTIVE INNOVATIONS ARE CHANGED TO FIT THE
SYSTEM EXISTING SYSTEM IS CHANGED TO SUPPORT THE EFFECTIVENESS OF
THE INNOVATION EFFECTIVE INNOVATION System Change Allison Metz,
NIRN, 2013
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National Implementation Research Network
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EBHV Evaluation Theory of Change 23 Mathematica Policy
Research, 2013
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Infrastructure Capacities 24 Foundation activities Planning
Collaboration Implementation activities Operations Workforce
development Sustaining activities Fiscal capacity Community and
political support Communications Evaluation
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project dulce incorporates interventions into the pediatric
primary care setting through the Patient Centered Medical Home
Model 25
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South Carolina a workforce enhancement intervention and an EB
parenting intervention for families with young children with
developmental disabilities. 26
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Embrace complexity! 27
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Why are the best programs working? Theoretical integrity and
focused content. Focusing intervention efforts on the earliest
stages of the developmental process. Employing persistent, but
respectful, outreach methods to engage multi-problem families.
Systematically assessing the needs of the target population across
a number of domains that impact relevant risk and protective
factors. Providing participants access to a core body of knowledge
and skills and facilitating access to other community resources as
needed. Deb Daro, Pew Summit, Feb 2013 28
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We are in it for the long haul.. 29
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http://friendsnrc.org/vision-videohttp://friendsnrc.org/vision-video
and http://friendsnrc.org/network-for-action
http://friendsnrc.org/network-for-action 30
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Contact Information Melissa Lim Brodowski Office on Child Abuse
and Neglect Childrens Bureau phone: 202-205-2629 email:
[email protected]@acf.hhs.gov 31