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County of Humboldt Department of Health and Human Services Evidence Based Practice (EBP) Systems Change To Insure Success Rose Jenkins Conference October 3 – 4, 2006.

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Ebp systems change to insure success

County of Humboldt

Department of Health and Human Services

Evidence Based Practice (EBP)

Systems Change To Insure Success

Rose Jenkins Conference

October 3 – 4, 2006


Ebp systems change to insure success

With the help of the California Institute for Mental Health, the interrelated and dynamic processesthat link these program support divisions have been designed and piloted.These processes are a unique approach in terms of our organizational transformational work.

They represent Humboldt County’s developmental efforts towards the identification of interrelated systematic government sector “Rapid Cycle” processes required to initiate service transformation (e.g., EBP’s).


Current mhsa related evidenced based practices launched
Current MHSA Related EvidencedBased Practices Launched:

  • Multidimensional Treatment Foster Care (MTFC): A foster care placement and after care program for youth ages 12-18, chronic juvenile offenders extending 6 months for placement and up to 12 months after care services.

  • Incredible Years (IY): Parenting treatment and prevention program for parents with children ages 2-12 who exhibit conduct or behavior problems.

  • Functional Family Therapy (FFT): Family treatment for youth ages 11-18 who are at risk and/or presenting with delinquency violence, substance abuse, conduct behavior problems and family conflict.

  • Aggression Replacement Therapy (ART): For adolescent youth who show or are at risk of aggressive behavior.


Current mhsa related evidenced based practices launched cont d
Current MHSA Related Evidenced Based Practices Launched (cont’d):

  • Family to Family:Developing family resources and Team Decision Making models for families whose children are in or at risk of out-of-home placement.

  • Parent Child Interaction Therapy (PCIT): Intensive treatment designed to work with parents and children together and teach parents skills necessary to manage their children’s behavioral problems ages 2-7.

  • CalMap:Medication algorithm-based clinical decision making tool to assist physicians in treatment of schizophrenia and schizoaffective disorder. Roadmap to recovery education program for clients.

  • Project Impacts:Project examining physician attitudes toward medication algorithms with specific attention to computer assisted algorithm implementation and its effect on physician adherence to major depression recommendations.


Questions answers
Questions & Answers (cont’d):

  • What is Starship?

    • Starship is Humboldt County’s DHHS “nickname” for a governmental “Rapid Cycle” Change Management process prototype.

  • What is a “Rapid Cycle” process?

    • A Rapid Cycle process is a structured method to efficiently implement changes in an organization.

    • While there are several private sector models, Starship was developed with the California Institute for Mental Health to manage change in a governmental environment (i.e., DHHS).


Questions answers continued
Questions & Answers, continued (cont’d):

  • What is the basic function of each structure?

    • The functions vary depending on the project and stage of the process but can generally be defined as:

      • Administrative/Stakeholder function(s)

        • To identify an issue or program (new or existing) that should be studied.

        • To activate the Starship program support units.

        • To approve final recommendations and assure “Mothership” resources (e.g., IT/Financial Services/Employee Services/QI/Office of Client and Cultural Diversity) and Branch support and linkage are provided.


Research and evaluation unit function s
Research and Evaluation Unit Function(s) (cont’d):

  • To provide data on an identified issue or program in concert with Branches.

  • To provide literature reviews on Evidence Based Practices/information to Administration and Stakeholders.

  • To recommend and develop data and outcome approaches in conjunction with IT, Branches and needed Starship units.

  • To provide formative and summative outcome data to Administration, Stakeholders and Branches.


Training education unit function s
Training & Education Unit (cont’d):Function(s)

  • To provide or contract for pre-launch training and education to Branches and Stakeholders.

  • To provide or coordinate post-launch or ongoing training and education needs.


Integrated services unit function s
Integrated Services Unit (cont’d):Function(s)

  • To provide assistance to Branch project lead(s) and assure linkage when technical assistance occurs.

  • To assure Starship units and Branches interact efficiently in the Rapid Cycle process needed to achieve the current objectives of an issue/program undergoing change.

  • To link with Branches and “Mothership” supportive services to assure program maintenance is provided.


Ebp systems change to insure success

12 (cont’d):


Ebp systems change to insure success

18 (cont’d):


Ebp systems change to insure success

19 (cont’d):


Ebp systems change to insure success

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Ebp systems change to insure success

County of Humboldt (cont’d):


Macro to micro or what we re doing and why we re doing it

AB 1259 (introduced by Assemblywoman Virginia Strom-Martin) = an integrated and comprehensive County health and human services system. AB 1881 (authored by Assemblywoman Patti Berg in 2004), authorized continuation of Humboldt County’s transformation work.

AB 1881 goals, values and outcome expectations have guided Humboldt County in the development of its integrated system since 1999. The Mental Health Services Act and Welfare Redesign initiatives have helped to broaden and focus these efforts.

Macro to Micro or “what we’re doing and why we’re doing it”


Macro to micro continued
Macro to Micro = an integrated and comprehensive County health and human services system. AB 1881 (authored by Assemblywoman Patti Berg in 2004), authorized continuation of Humboldt County’s transformation work. (continued)

  • The fundamental concept underlying all of our change efforts has been that high quality, early, community and strength based intervention strategies result in the best long term outcomes for our clients.

  • The following goals and outcomes were embedded in AB 1259 and 1881 and reflected the priorities of DHHS Administration, Branch Management as well as the Mental Health Services Act and Welfare Redesign.


Ebp systems change to insure success
Specifically the Department, through its integrated program development and integration process, has and continues to be focused on:

  • Increasing alcohol and drug services to the “working poor”.

  • Co-occurring disorder intervention strategies where and when appropriate.

  • Integration of all program planning processes.

  • Recovery, resiliency, harm reduction and wellness oriented programming.

  • Evidence Based Practice and Practice Based Evidence initiatives that are measurable and outcome based.

  • The development of a foster care “continuum of care”.

  • Acknowledging and enhancing Transition Age Youth voice and role aimed at increasing their self sufficiency.


Ebp systems change to insure success

Focus development and integration process, has and continues to be focused on:(continued)

  • Differential response.

  • Ensuring that all children in our health and human service system receive mental health and health screenings.

  • Keeping all minors in County.

  • Improving access for services throughout County wherever clients live. Development of mobile service system.

  • Promoting integrated and multi-disciplinary oriented programming wherever possible and indicated.

  • Services being culturally relevant and reflective of diversity competence.


Ebp systems change to insure success

Focus development and integration process, has and continues to be focused on:(continued)

  • Strengthening the relationship between DHHS Branches and community service providers.

  • Prevention and early intervention.

  • Reducing the number of children removed from home due to safety/neglect issues.

  • Reducing repeat foster care placements and the maltreatment of children while out of home.

  • Shortening the amount of time to permanency.

  • Keeping families and/or sibling groups intact.

  • Increasing professionalism of our work force.

  • Quality Improvement and data collection focused.


Transition steps
Transition Steps development and integration process, has and continues to be focused on:

  • Development of the organizational structure necessary to transform the system.

    CIMH for technical assistance on

    • Administrative restructuring

    • EBP/Lit Search

    • Cultural Competence


County of humboldt
County of Humboldt development and integration process, has and continues to be focused on:


Integrated services and supports

Integrated Services and Supports development and integration process, has and continues to be focused on:


Identified primary functions
Identified Primary Functions development and integration process, has and continues to be focused on:

  • Implementation Planning

  • Research & Evaluation

  • Training, Education & Supervision

  • Resource Development


Developed guides and reporting structures for implementation
Developed Guides and Reporting Structures for Implementation development and integration process, has and continues to be focused on:

  • What is the implementation process and structure?

  • Who needs to be involved in the implementation process?

  • What is the reporting process, who needs to be in the loop?

  • How will this be a transparent reporting process?


Implementation guide
Implementation Guide development and integration process, has and continues to be focused on:

  • Designed to support planning

  • Planning completed by inter-agency/intra-agency implementation team

  • Shared implementation process


Implementation team members
Implementation Team Members development and integration process, has and continues to be focused on:

  • Integrated Services Program Manager

  • Program Lead

  • Referral Source—Designated Manager

  • Fiscal

  • Research & Evaluation Staff

  • Information Systems Staff

  • Training Coordinator

  • Facilities & Equipment Staff

  • Quality Assurance Staff

  • Office of Client & Cultural Diversity

  • Employee Services

  • Community, family, youth, consumer partners


Key roles of implementation team members

Key Roles of Implementation Team Members development and integration process, has and continues to be focused on:


Integrated services manager
Integrated Services Manager development and integration process, has and continues to be focused on:

  • Facilitate and oversee implementation process

  • Partner with assigned Program Lead to meet and develop action plan for implementation

  • Provide transparent reporting to governing body


Implementation team
Implementation Team development and integration process, has and continues to be focused on:

  • Identify program lead

  • Identify how it fits in the organization

  • Embed in everyday business


Designated referral source
Designated Referral Source development and integration process, has and continues to be focused on:

  • Manage and monitor referraldevelop internal structures and policy

    • Identify target population within the organizational structure for the practice

    • Partners with the practice provider to make sure referrals are made to the practice

    • Develop engagement strategies to follow-up with potential referrals.


Fiscal
Fiscal development and integration process, has and continues to be focused on:

  • Develop funding strategies

  • Develop monitoring process

  • Assist with budget (cost/revenue analysis)

  • Identify sustainability

  • Monitor following implementation


Research evaluation
Research & Evaluation development and integration process, has and continues to be focused on:

  • Conduct needs assessment

  • Review/summarize literature

  • Establish fidelity & outcome measures

  • Produce audience specific reports


Ebp systems change to insure success

Other Key Systems/Roles development and integration process, has and continues to be focused on:

  • Information Systems

  • Training

  • Facilities & Equipment

  • Quality Assurance


Implementation process
Implementation Process development and integration process, has and continues to be focused on:

  • New Program Description

  • Target Population Identified

  • Fiscal

  • Staff Selection

  • Training & Clinical Supervision

  • Fidelity & Outcome Measures

  • Facilities & Equipment

  • Information Systems

  • Quality Assurance


Developed two reporting documents reporting structure
Developed Two Reporting development and integration process, has and continues to be focused on:Documents & Reporting Structure

  • Evidence Based Practice New Program Report

  • Rapid Cycle (EBP) Program Update Summary Report

  • Reporting StructureMonthly written reports to governing body


Training education and supervision
Training, Education and Supervision development and integration process, has and continues to be focused on:

  • Established a DHHS Branch Tri-Chair Training Committee, serves in advisory capacity to the Training Education Supervision Unit

  • Requested that each Branch and DHHS add a training section to their website, IS to link them to each other

  • Tri-Chair Training Committee Chairs are sharing their training fliers with Branches and DHHS

  • Training Unit has developed a training calendar, identifying Branch sponsorship, updated each month in the newsletter

  • Hired Staff to provide training and clinical supervision


Ebp systems change to insure success

County of Humboldt development and integration process, has and continues to be focused on:


What is pcit
What is PCIT? development and integration process, has and continues to be focused on:

PARENT CHILD INTERACTION THERAPY

  • Brief Therapy model

  • In vivo parent coaching focusing on development of specific parent competencies.

  • Emphasizes relationship enhancement and effective discipline for children with acting out behaviors that are at risk of maltreatment.


Outcomes
Outcomes development and integration process, has and continues to be focused on:

  • Increases parent and child mental health functioning through structured, intensive modeling of praise and consistent expectations for behavior.

  • Reduced referral rate to child welfare system.

  • Skills taught generalize to other children in family.


What has worked well
What has worked well: development and integration process, has and continues to be focused on:

  • High consumer satisfaction

  • Positive outcomes

  • Objectives of the treatment model meet vision of all branches of department


Challenges
Challenges development and integration process, has and continues to be focused on:

  • Placement and construction of site

  • Research and evaluation component for outcome measurement.

  • Staffing patterns

  • Dedication of staff for training and initial implementation.


Resources
Resources development and integration process, has and continues to be focused on:

  • Parent Child Interaction Therapy (Hembree-Kigin & McNeil, Plenum Press 1995)

  • UC Davis PCIT training website (http://www.pcittraining.tv/)

  • Spending Smarter: A Funding Guide for Policymakers and Advocates to promote Social and Emotional Health and School Readiness – National Center for Children in Poverty (http://nccp.org/media/ss05_text.pdf)


Ebp systems change to insure success

County of Humboldt development and integration process, has and continues to be focused on:


Incredible years overview
Incredible Years Overview development and integration process, has and continues to be focused on:

  • Three Separate IY Components:

    • Parent Training (Early Childhood & School Age)

      • BASIC Parent Training- (12-14 wks)*

      • SCHOOL (Supporting Your Child’s Education)

      • ADVANCE Parent Training (10-12 wks)

    • Teacher Training

      • Classroom Management (42 hr teacher training)

      • Classroom Dina Dinosaur (small group pull out 2x wk)

    • Child Training

      • Dina Dinosaur – Social Skills/Problem Solving –

      • Small Group Training.


Incredible years outcomes
Incredible Years - Outcomes development and integration process, has and continues to be focused on:

  • BASIC Parent Training –

    • Improved Parental Attitude & Parent/Child Interaction

    • Reduced Parental use of violent forms of discipline

    • Decreased Child Conduct Problems

  • ADVANCED Parent Training –

    • Improved Parental problem solving & communication

    • Increased Child social & problem solving skills

    • Reduced Maternal Depression


Incredible years outcomes1
Incredible Years - Outcomes development and integration process, has and continues to be focused on:

  • Dina Dinosaur –

    • Improved social skills & conflict management

    • Less classroom aggression


What has worked well for us in the last year
What has worked well for us in the last year? development and integration process, has and continues to be focused on:

  • Boosters

  • IY Daycare

  • Home Visits


Challenges1
Challenges development and integration process, has and continues to be focused on:

  • Evening Course Facility

  • Sessions where no one had custody

    of their children

  • Parenting skill levels


Challenges continued
Challenges development and integration process, has and continues to be focused on:(continued)

  • IY Hat issue

    • SSB/CWS

    • PHB

    • MHB


Incredible years what does it take to get started
Incredible Years: development and integration process, has and continues to be focused on:What does it take to get started?

  • Staffing: 2 facilitators, 0.25 FTE each

    2 Vocational Assistants, 1.5 FTE

  • Costs: Initial – curriculum, training, equipment, toys, course materials, rewards, location.

  • On-going: Staffing, food, course materials, rewards, location, transportation.

  • Funding Sources: CWS Redesign, Medi-Cal (EPSDT), and fee for service.


Resources1
Resources development and integration process, has and continues to be focused on:

  • Implementing Behavioral Intervention Components in a Cost-Effective Manner: An Assessment of the Incredible Years Program (3/18/2005): Olchowski, A., Foster, E. Michael, & Webster-Stratton, C.

  • Building on Strengths: Current Status and Opportunities for Improvement of Parent Training for Families in Child Welfare (draft): The Brookings Institution

  • Working with Families Who are Involved in the Child Welfare System (8/7/2005): Webster-Stratton, C. & Reid, J.M.