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IMPLEMENTING FUNCTIONAL FAMILY THERAPY. Population of Need. Children and young people known to CYF or CAMHS services who are living at home and who have moderate to severe conduct problems.
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Population of Need Children and young people known to CYF or CAMHS services who are living at home and who have moderate to severe conduct problems. They are at risk of out-of-home care and often have associated substance abuse, mental health problems, criminal behaviour and educational failure.
Youth Horizons in 2008 • Evidence-base limited • High variability in quality • High variability in practices • High cost • Outcomes uncertain
Evidence to service gap • Often, the most effective strategies are not used for young people and their families • There are often no clear pathways for effective implementation • Then what is adopted is not used with fidelity and good effect • What is implemented often disappears with time and staff turnover (Fixsen et al, 2005)
Strategy 1: Detailed planning with incremental commitment steps • Literature review on EBP • Due diligence – pros and cons • Business case for FFT and Multidimensional Treatment Fostercare • Little commitments build big commitments • Access to expertise and a well honed implementation plan
Why implement FFT? Why choose FFT? • What is FFT? • Excellent evidence base– no superior alternative • Cost effective • Proven dissemination success at multiple sites • Alignment with YH and Māori cultural values • Community and family based with geographic flexibility • Training and quality assurance processes • Long-term ability to conduct own consultancy and training
Strategy 2: Face into the question ..is it culturally appropriate and supported by our cultural leaders? • We made it a deal breaker • Cultural due diligence • Kanohi ki te Kanohi • The adaptation question
Strategy 3: Provide vision led consultation on proposed change • Change management strategy developed • Consultation conducted • Affected staff supported • Relationships, Leadership and good communication essential
Strategy 4: Optimise the three factors of success -National Implementation Research Network (NIRN) External factors Support for evaluated programs Support for adequate referral numbers Sustainable funding strategies (for services and QI) Organisational factors Fit with the agency mission Therapist/supervisor selection and support Commitment of resources to support program Commitment to data-outcomes Core model factors All model components and QI activities adhered to
Proposed Relationships between Factors and OutcomesNational Implementation Research Network (NIRN) Thus, every program, organisation, system decision is in the end a clinical – outcome decision
Funding and Outcomes Outcomes • Pilot study by Professor Ferguson close to publication • MSD funding – investment approach • Routine outcome data (fidelity, Realtime feedback, pre-post measures, Family rated outcomes) • Quality Assurance processes – PDSA cycles • Organisational culture– data informed, quality focused, growing cultural competence • The white, black and red threads