Developing an evidence informed context for Family Service intervention and evaluation .

1. Developing an evidence informed context for Family Service intervention and evaluation. Julie Boffa, Project Manager, NEMC&FSA John Cheshire, Senior Manager, Community & Family Services, Brotherhood of St Laurence; Executive representative, NEMC&FSA ACWA 2010

2. About the project • Began from a re-occurring frustration when Family Services team leaders met: what can we do to help children when parents don’t change? • Lead to the idea of a research project exploring interventions that make a difference • A partnership between the NEMC&FSA and the PRC, substantially funded by a grant from the Ian Potter Foundation

3. Who is the NEMC&FSA? North East Metro Child & Family Services Alliance • 9 community service agencies, in partnership with Child Protection, bound by MOU • Formed in 2007 to provide Integrated Family Services for children at risk of report to Child protection, or with substantial difficulties • Supported by central intake, Child FIRST • Services 5 LGAs - population the size of Tasmania; highest metro Aboriginal pop; many indicators of disadvantage.

4. Our clients in brief • For 2008-09, 89% of families referred to Child FIRST had one or more complex characteristic: • Child Protection involvement • Mental illness • Substance abuse • Family violence • Physical or intellectual disability • Sexual assault • Juvenile Justice involvement • 46% had known prior or current Child Protection involvement at the point if intake • Children may demonstrate a range or emotional and behavioral issues

5. What is the Parenting Research Centre? • Australia's only independent national Centre dedicated to research and development in parenting support • Core business is developing, delivering and supporting parenting programs • Specialises in bridging the research to practice gap through dissemination of evidence based solutions • Numerous large scale national projects

6. Project objective • To develop “A blueprint for family support intervention and evaluation” • That draws upon and generates research evidence • Through continuous input and feedback from our workers, resourced by access to evidence through the PRC

7. What is a blueprint? • “Photographic print representing final stage of engineering or other plan, (fig) detailed outline or plan” (Pocket Oxford) • Blueprints may be multi aspect contours (8) or technical drawings or specifications (9) • Our blueprint will include aspects of both, while recognising that the finishing, like the art of practice, is an unique combination of families, practitioners and context

8. Multi aspect contours

9. Technical Drawings

10. What is the art of practice? • Recognises that 70% of difference between models or techniques is due to worker & clientfactors(Wampold, 2001) • Practice therefore cannot be prescribed, but can be informed…

11. An informed art • “There is an art to social work practice, but it is an informed art, born of a balance between the structured, general knowledge that prepares the practitioner for categories of concern, and the intuitive, improvisatory understanding that is expressed in the immeasurable details of being fully present to another human being”(Graybeal, 2007:514) • “The cumulative evidence supports a comprehensive, artistic, improvisatory, and relational conception of practice, informed by structured feedback and evaluation”(Graybeal, 2007:514) • Structured feedback and evaluation: Are we dong what we said? Does it make a difference? Improves clinical outcomes by as much as 50% (Miller, Duncan, Sorrell & Brown 2005 cited by Graybeal, 2007:520)

12. Evidence informed practice Family Evidenced based practice Characteristics and consequences established through research that inform what a practitioner can do to produce a desired outcome (Dunst 2009) Evidence for practice Practice based evidence Individual & collective wisdom across contexts; Concurrent evidence gathering of service effectiveness (Moore 2010) Evidence from practice Worker Art of practice: Improvisation Knowledge-wisdom-values What works for who, when, where, why

13. Access to evidence • Lack of access is a barrier to research dissemination and uptake in practice • Workers are time poor and become easily over-whelmed by options (Lewig, Arney and Scott, 2006) • There is plenty of research • The question is: What fits for who, when, where - and how?

14. What fits for who, when, where? • We have drawn heavily on the PRC to shape our answer through: • Meetings with Team Leaders and senior practitioner on a number of occasions over 2009 for PRC to understand the context of our practice and bring offerings from theirs – research of relevance to the workers’ world • Culminating in a “Model Development Day”, also involving agency managers, to scrutinise and select research applicable to our objectives

15. How ? - the driving question • The PRC constantly pushed workers to move past describing who they worked with and what were their roles to describe ‘how’: • When you engage with a family what do you say? • When you want parents to change their behaviour what do you do? • Why did you decide to do that then?

16. Not programs but ‘kernels’ • Many ‘programs; have research support, albeit to varying degrees, for example • Family Nurse Partnerships – antenatal – 2years • Project Safe Care – 0-5 years • Mulitisystemic therapy – 12-17 years • ‘Programs’ however are too narrow for our context- children & young people across multiple ages, multiple presentations & multiple agencies • Quest instead for ‘kernels’ - active ingredients to change, common across multiple programs (Embrey & Biglan, 2008)

17. Where have we got to? • Blueprint contours • Family Services roles • Family Services context: professional development, supervision, management endorsement, & more • Blueprint technical drawings • ‘Evidence informed actions for family services’

18. Family Services roles • Getting started • Address barriers, build motivation to change, joining with family • Agreeing roles, goals and feedback • Clarity of roles & purpose; Feedback driven assessment; strengths • Multi modal developmental guidance • Child development - Parent skills – Parent-Child interactions • Practical support • Material aide, immediate supports, advocacy • Bolstering inclusion • Strengthen family, community and professional connections, multi- agency work • Emotional support • Strengthen positive self attitudes & activities, demonstrate warmth • Helping parents provide physical & emotional safety • Interface with specialist focused services, safety plans • Unravel blocks to change • Personal, inter-generational, systemic, organisational

19. Evidence informed actions • Best research evidence to resource workers with actions that make a difference • Not comprehensive across all roles, but identified as key based on re-occurring prominence in literature and areas NEMC&FSA identifies as priorities • To be supported by detailed implementation plan and sustainable, routine measurement

20. Blueprint: Family services roles with evidence informed actions • Building commitment to change • Motivational interviewing • 25 year review of 119 Motivational Interview studies (Lundahl et al, 2009) found MI significantly increased clients’ engagement in treatment and their intention to change

21. Phase two: Implementation of evidence informed actions Implementation to be supported by: • Ongoing PRC role providing • In-service training • Ongoing coaching & consultation • Staff & performance evaluation • NEMC&FSA management endorsement • Governance through Executive sub committee • Sign-off of implementation plan • Routine reporting and feedback about progress

22. References • Embrey, D.E. & Biglan A. 2008 Evidence Based Kernels: fundamental units of behavioral change Clinical Child &Family Psychological Rev 11:75–113 • Graybeal C.T. 2007 Evidence for the Art of Social Work Families in Society: The Journal of Contemporary Social Services, 88(4): 513-523 • Lewig, K, Arney, F. & Scott, D. 2006 Closing the research-policy and research-practice gap: Ideas for child and family services Family Matters, No. 74, Institute of Family Studies • Blueprints retrieved on 14 June from • http://www.the-blueprints.com/ & • http://www.google.com.au/images?hl=en&q=blueprint+buildings&um=1&ie=UTF&source=univ&ei=NEEWTNrxGMSeceGGzZcM&sa=X&oi=image_result_group&ct=title&resnum=4&ved=0CDMQsAQwAw