The 4r s and 2s s learning collaborative lc
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The 4R’s and 2S’s Learning Collaborative (LC). Quality Improvement Team Webinar Children’s Technical Assistance Center (CTAC) Website: AGENDA. Welcome to clinics joining the LC The 4R’s and 2S’s model: What is it? Why is it important?

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The 4R’s and 2S’s Learning Collaborative (LC)

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The 4r s and 2s s learning collaborative lc

The 4R’s and 2S’s Learning Collaborative (LC)

Quality Improvement Team Webinar

Children’s Technical Assistance Center (CTAC)




  • Welcome to clinics joining the LC

  • The 4R’s and 2S’s model: What is it? Why is it important?

  • The ABC’s of a Learning Collaborative

  • Proposed schedule of LC Activities (October 2011- June 2012)

  • Q&A



  • You are one of over 60 clinics statewide who have expressed an interest in joining the 4R’s and 2S’s Learning Collaborative

  • The clinics who join are the “early adopters”- those who are committed to improving their services.

  • We very much appreciate your commitment- as an early adopters you are the innovators who contribute to the field and help to improve the entire system

The 4r s and 2s s multiple family group program what is it

The 4R’s and 2S’s Multiple Family Group Program: What is it?

  • This curriculum-based practice is designed to strengthen families, decrease child behavioral problems, and increase engagement in care.

  • The program focuses on parts of family life that have been empirically linked to youth conduct difficulties.

  • The program is available in English or Spanish.

  • The 4R’s and 2S’s is a research informed treatment approach designed to improve parent- child interactions resulting in positive improvements in the child’s social behavior and the caregivers parenting behaviors.

Poll question 1


Does your clinic offer group treatment?

If yes, what type of group program?

The 4r s and 2s s stands for

The 4R’s and 2S’s stands for:

  • R ules

  • R esponsibilities

  • Respectful Communication

  • Relationships

  • S tress

  • Social Support       

The 4r s and 2s s learning collaborative lc

What is the 4R’s and 2S’s for

Strengthening Families Program?

  • Reduces stigma associated with raising a child with mental health issues by normalizing each family’s experience

  • Emphasis on building family relationships and functioning

  • Each session provides time for families to practice togetherness and communication

  • Emphasis on “Roadwork”, which promote continued learning outside the group

The 4r s and 2s s learning collaborative lc

What is the 4R’s and 2S’s for

Strengthening Families Program?

  • Group format

  • Meets at least once a week for 16 weeks

  • Optimally closed group after session 3

  • Group size = 6-8 families

  • Ideally, co-led with parent advocate

  • Groups typically run for 60 minutes

  • Manuals used by families and facilitators

Why is the 4r s and 2s s program important

Why is the 4R’s and 2S’s program important?

The literature tells us that families that participate in the program are likely to experience the following outcomes:

  • Increased family cohesion

  • Increased within family support

  • Increased family communication

  • Decreased oppositional defiant behaviors

  • Decreased child inattention

  • Decreased parenting stress

  • Decreased problematic parent-child interactions

  • Families stay longer in treatment

What is a learning collaborative

What is a Learning Collaborative?

  • Network of clinics committed to implementing and sustaining an evidence based practice designed to strengthen family relationships and promote positive social behavior in children with conduct difficulties

  • The learning collaborative brings together 10-15 child serving clinics who share with and learn from each other through collective problem solving and social networking.

Poll question 2

Poll Question #2

Have any of you previously participated in a

Learning Collaborative?

Abc s of lc the overall aims

ABC’s of LC: The Overall AIMS

Each participating clinic will…..

  • Successfully plan, implement and complete the 4R’s and 2S’s 16 week multiple family group treatment program.

  • Explore strategies to sustain the 4R’s and 2S’s program (assuming positive outcomes) after the LC ends in June 2012.

  • Be offered an optional opportunity to experiment with applying the 4R’s and 2S’s approach to an 8 week program and/or individual treatment modalities.

The abc s of a learning collaborative your expert panel

The ABC’s of a Learning Collaborative: Your Expert Panel

  • Your LC is organized and guided by a panel of “experts” who provide the needed clinical, technical and social supports to achieve the aims of the LC.

  • Your expert panel are faculty of CTAC.

    For more information about your expert

    panel see the CTAC website at CTACNY.COM

Abc s of the lc what your expert panel provides

ABC’s of the LC: What your expert panel provides

  • The expert panel provides guidance on how to successfully implement a new practice by:

    • Organizing and facilitating all activities associated with the LC

    • Establishing practical and effective communication channels between and among the members of the LC and the expert panel members

    • Providing high quality training and ongoing support for the staff implementing and providing the new practice

    • Supporting supervisors to promote the development of the staff implementing the program

Abc s of the lc what your expert panel provides1

ABC’s of the LC: What your expert panel provides.

One of the key approaches employed by the expert panel involves assisting each clinic to apply easy to use performance improvement methods :

  • Plan-Do-Check-Act improvement cycles

  • Identification of measureable performance indicators

  • Focus on practical strategies that make sense in the day to day realities of a clinic

The abc s of a lc the role of the clinic

The ABC’s of a LC: The role of the clinic

What do the participating clinics bring to the table?

The quality improvement team qit

The Quality Improvement Team (QIT)

Each organization identifies and empowers a Quality Improvement Team (QIT) who participate in all the LC activities and take responsibility for planning, implementing and evaluating the aims of the LC.

The QIT is the interface between their organization and the LC.

The qit who should be involved

The QIT: Who should be involved?

  • QIT membership typically includes:

    • an executive-level administrator

    • clinical supervisor of the program that is the focus of the improvement effort

    • person responsible for collecting and submitting data related to performance indicators.

  • Others may also join the QIT based on the aims of the LC (e.g., cultural diversity expert, peer specialist, partnering organization representative)

    • In the 4R’s and 2S’s project, the inclusion of a family advocate/parent partner would be very helpful

Poll question 3


Does your clinic have a relationship with a family advocate, family partner or family support organization?

Performance indicators

Performance Indicators

  • The identification of key performance indicators that are measurable and allow LC members to assess progress and address challenges is an integral component of a LC.

  • The identification of performance indicators promotes and strengthens the experience of a “community” among participants by establishing a number of common goals and measures.

Performance indicators1

Performance indicators

  • The performed indicators employed in the 4R’s and 2S’s LC include:

    • Weekly Attendance (the number of families that were enrolled in the 4R’s and 2S’s program and the number that attended)

    • Discontinuation and reasons why (# of families that discontinued during a month and the factors contributing to discontinuation)

Performance indicators cont

Performance Indicators (cont)

  • Family Feedback (completed by participating family members at the beginning , middle and end of the program)

    • Built into the 4R’s and 2S’s manual

    • Focuses on child behavior and aspects of family life

  • Facilitator feedback (at end of program the group facilitator(s) provide feedback on their experience of the program)

Performance indicators cont1

Performance Indicators (cont)


  • A way of helping facilitators to apply their skills in the program.

  • Supervisors will be involved in assessing fidelity by directly observing a group and completing a fidelity assessment instrument.

  • The fidelity feedback is not part of the practitioners performance evaluation. Rather, the focus is on educational supervision.

  • Opportunity to conduct fidelity via an independent rating

What are the learning collaborative activities

What are the Learning Collaborative Activities?

The 4R’s and 2S’s LC is likely to include the following activities:

  • 3 face to face meetings of the QIT’s over the 9 month duration of the LC

  • Typically, one monthly contact with the QIT’s via one of the following modalities:

    • Individual call

    • Group conference call

    • Special interest calls ( based on the expressed needs of the LC members as the project progresses)

Learning collaborative activities staff training

Learning Collaborative Activities: Staff Training

  • One day staff training in facilitating a 4R’s and 2S’s multiple family group

    • Minimum of 2 practitioners (clinical staff, interns) along with a family advocate/partner

    • Consider sending additional staff who may be interested in learning the program and may support your efforts to sustain and/or expand the program.

  • Training is a practical hands on learning experience with a manual used by the group facilitators and the families

  • Training will begin in November 2011

Poll question 4


  • What percentage of your services for children involves one or more family members on an ongoing basis? Best estimate.

  • Less than 25 %

  • 26-50 %

  • More than 50%

Tentative schedule of lc activities

Tentative Schedule of LC Activities

Keep in mind…..

  • CTAC will make adjustments based on the needs and preferences of the LC participating clinics

  • CTAC is always available to consult with clinics to address clinic specific/unique concerns and challenges

The 4r s and 2s s learning collaborative lc


The 4r s and 2s s learning collaborative lc


The 4r s and 2s s learning collaborative lc


For more information or clarification on the 4R’s and 2S’s learning collaborative, please feel free to contact your LC facilitator and/or your regions logistics coordinator listed below.


Mary McKay (NYC and Lower Hudson- group A) [email protected]

Andrew Cleek (NYC and Lower Hudson- group B&C) [email protected]

Anthony Salerno (Long Island) [email protected]

(New York University partner representative)

Thomas Jewell (Central/Western and Upper Hudson River) [email protected]

Logistics Coordinator

Ashley Fuss (NYC, Long Island): [email protected]

Dianne Bailey (Western/Central and Upper Hudson) [email protected]

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