Transcript Articulating A Practice Model Of Service Integration

Articulating A Practice Model Of Service
Integration
Alberta College of Social Workers Annual Conference
2008
Scott Smillie, BSW; RSW
Christa Gilroy, BSc., Human Ecology
Valerie Streit, BA.,RLS
Susan Watson, BSc., Home Economics
Introductions: Round Robin
Workshop participants to introduce themselves, interest in the
workshop topic, and their learning interests/objectives for this
workshop.
Presenters Workshop Objectives:
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Share our experiences and learning.
Receive input into “The Model”.
Objectives
You Will:
 Learn about a community based research project,
focused on discovering the benefits of service
integration for low-income families.
 Explore the development process and how program
development and community engagement fit within
the process.
 Hear about the complexities and key processes of
community based research within the context of a
paraprofessional, multi-sectoral, Randomized
Control Trial
Objectives: cont.
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Learn about the Families Matter Partnership Initiative (FMPI)
program, practices conceived, (practice theories & principles
adopted) and the need/importance of developing and providing
a conceptual program model for management purposes.
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Explore the concepts imbedded within the “Ecological Model of
Service Integration” and provide input regarding its validity.
Historical Context
Dec. 2000 – Release of “Listen to the Children” by Quality of Life
Commission.
June 2001 – Decision made to focus on improving existing
services.
March 2002 – Workshop on “When The Bough Breaks” &
“Benefitting all the Beneficiaries”.
August 2003 – Logic Model Initiated
July 2005 – RFP went out.
Aug. 2005 – YMCA granted service delivery contract.
January 2006 – FMPI started receiving referrals from research
recruitment and data collector team.
Alberta Context:
Support to Low-Income Families
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In Edmonton, about 27,000* families (15% of all
Edmonton families) are considered low income, and
struggle to make ends meet.
These families have limited resources, often barely
enough to pay for food and shelter.
As well, they often have little opportunity to learn
skills, access preventive health care, or enjoy family
activities.
*Urban Poverty Project, CCSD, 2001
Support to Low-Income Families
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Although there are agencies and supports
available to help, these families also have
difficulty accessing supports.
Transportation, awareness, language, and
culture are among the barriers to accessing
supports.
Families with low-incomes are also more
likely to have other social and health needs.
Support to Low-Income Families
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Interpersonal/family relationships, life skills,
parenting…or just the ability to play.
Difficulty with these issues can put stress on
the whole family.
Supporting families can help build on their
strengths, set goals, and make dreams come
true.
But, how do we know what works best?
Who is Families First Edmonton?
Families First Edmonton is a partnership with two
co-leads, Alberta Employment, Immigration &
Industry, and the City of Edmonton Community
Services.
They are joined by 10 other organizations, a
service provider, and researchers from the
Community-University Partnership at the
University of Alberta.
Partners In Families First Edmonton
Project Co-Chairs:
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Alberta Employment, Immigration & Industry
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City of Edmonton Community Services
Service Delivery Providers:
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YMCA of Edmonton
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Multi-cultural Health Brokers Cooperative
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Bent Arrow Traditional Healing Society
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KARA Family Resource Centre
Members:
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Alberta Children’s Services
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Alberta Health and Wellness
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Alberta Mental Health Board
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Capital Health
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Edmonton Aboriginal Urban Affairs Committee
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Edmonton Community Foundation
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Edmonton & Area Child and Family Services Authority – Region 6
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Quality of Life Commission
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United Way of the Alberta Capital Region
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University of Alberta – Community – University Partnership for the Study of Children, Youth, and Families (4
Universities Involved).
What is Families First Edmonton?
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Families First Edmonton is a $10 million research project to determine whether
delivering health, family support and recreation services in a coordinated way can
lead to better outcomes for families with low incomes. Families First Edmonton
seeks to determine the most cost-effective, efficient use of resources to proactively
assist families.
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The research project is based on a similar study conducted in Ontario by Dr. Gina
Browne. Her award winning study concluded that when families with low incomes are
provided health, social, childcare and recreation in a comprehensive and combined
way, families benefit more and governments realize cost savings. There was a desire
to build on the Gina Brown study, but within an Alberta context.
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Families First Edmonton will determine if similar positive results can be seen in
Alberta with an adapted and enhanced approach, that takes into account the
differences between Alberta’s and Ontario’s economy, social service environment,
legislation, programs and processes.
What is Families First Edmonton? Cont.
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FFE was seeded out of a broad realization that low-income
families receiving income support are not connecting with other
community services.
A research hypothesis arose that perhaps if we become more
deliberate in reducing barriers to services for families by
improving the integration of existing services, that families and
their children would experience improved health and
development outcomes.
A research framework and service delivery framework were
developed to test key research questions.
Research Framework:
Involved key research questions:
1.
Does FFE service delivery model enhance families’ access to established
services?
2.
What are the effects of the service delivery model on the quality of life of
family, type of service accessed, and the level of satisfaction families feel
toward the existing services?
3.
What are the costs to service systems of each of the service delivery models
over time?
4.
What are the achievement outcomes of the children, and physical and
psychosocial health outcomes of family members, over time, associated with
each of these delivery models?
5.
What are the role of problem solving skills, communication skills, and family
connections to community on the intervention effects of four service delivery
models, and how does this role change over time?
6.
Do socio-demographic characteristics influence the family linkages to
services and the outcomes in cost and health?
Research Approaches:
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FFE is a Randomized Control Trial (evidence
based)
FFE sought a sample size of 1200 families
A Recreation Pilot was implemented and
utilized to base some research decisions
upon.
Recruitment Targets and Strategies.
Participant Eligibility
•
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Eligible families contacted by mail at random
Completely voluntary
To be eligible, families must:
 have at least one child aged 0-12 years
 be receiving Alberta Works Income Support and/or Alberta
Child Health Benefit for the past six months
 live in designated area: north-central and north-east
Edmonton (This changed to city wide).
What Does Success Look Like?
Researchers will determine which approach most successfully achieves
the following outcomes among participants in the project:
Increases
appropriate access to existing social, health, and community
services
Enhances
physical and psycho-social health of the families
Increases
attendance and achievement at school
Decreases
the number of behavioural/emotional problems among
children in the study
Increases
self-reliance and enhances life management (e.g. grocery
shopping, appropriate child care, etc.)
What Does Success Look Like? - Continued
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Decreases use of emergency services (emergency medical
services, hospital emergency, child welfare, police, etc.) and
increases proactive use of health promotion services
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Is most cost-effective by avoiding future costs or being costneutral, while achieving better results
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Results in more efficient use of existing resources
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Increases the ability of agencies and organizations to work
together across sectors
Test 4 Service “Models”
1.
2.
3.
The Family Healthy Lifestyle Program: The family will
continue to receive the same services they do now plus a
family support coordinator helps the family solve problems
and link to health, education, child care, and family support
services in the community.
The Recreation Coordination Program: The family will
continue to receive the same services they do now plus a
recreation coordinator helps place the children (0-17 years)
into recreational programs with some funding provided.
The Comprehensive Program: The family receives the same
services they do now plus a combination of the Recreation
and Family Healthy Lifestyle Program
Test 4 Service “Models” - Continued
4.
Self-Directed Group
The self-directed group will continue to access high quality services in the
usual manner. Data will continue to be collected at intervals
consistent with the other three groups.
The self-directed group will allow researchers to compare the delivery
of the three service models to how services are delivered without
them.
Service Provider
The YMCA is contracted to provide services to
participating families.
The YMCA joined with the Multicultural Health
Brokers Cooperative, KARA Family Resource
Centre, and Bent Arrow Traditional Healing Society;
to coordinate a comprehensive array of services to
families involved with FFE. Together, they form
“Families Matter Partnership Initiative.”
Service Delivery Framework:
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Named FMPI (Families Matter Partnership
Initiative)
Separated from influences of research side.
Each program stream to be distinct.
All programs shared common practices.
4 Practice Pillars in Common: family centred;
culturally sensitive; capacity building,
reflective practice.
FFE models: assisted services
Models will enhance service integration and family capacity building
Recreation
Family Healthy
Lifestyle
• 300 families
• Rec. Assessment
• Active outreach
(placements, follow-up
& funding)
• Other needs self-directed
• Recreation Coordinators
Comprehensive
• 300 families
• Holistic Assessment
• Services based on needs
• Rec Assessment
• Placements, follow-up &
funding
• Family Support Coordinators
• 300 families
• Holistic Assessment
• Supportive brokerage
(service-links & follow-up)
• Recreation access not
funded
• Family Support
Coordinators
Overview of Service Delivery Framework &
Deliverables
A collection of theories
and principles from
various sources:
Type
Source
Ecological
Perspective
Research Proposals
Best Practices:
Reflective Practice
Capacity Bldg.
Family Centred
Practice
Cultural Sensitivity
RFP
Project Charter
3 Distinct Service
Streams
Recreation
Pilot
Documents
Research Proposals
RFP
Project Charter
Service Delivery Deliverables – Common To
Each Service Stream
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Quick engagement of families
Family Assessment
Goal Setting/planning
Progress Reports/monitoring
Intervention Fidelity
Learning Process To Service Integration
Active Outreach Approach
Mapping a Change Process and Goal Attainment with
NO timelines attached
Facilitating a Learning Process
(AwarenessKnowledgePracticalAttitude)
Tier 1
(Intense Engagement)
“I HAVE”
AWARENESS
Knowledge
Skills
Attitude
Initial
Contact 
Awareness
KNOWLEDGE
Skills
Attitude
Initial
 Assessment   IPP
Unique
Action Plan)
Secondary
Assessment
Referral
Tier 2
(Emerging, Maintenance
& Self-Sufficient)
Tier 3
(Transition & Closure)
“I CAN”
“I AM”
Awareness
Knowledge
SKILLS
Attitude
Awareness
Knowledge
Skills
ATTITUDE
 Implementation
- ie. Feedback from referring source
Ie. Involvement in programs
 Wrap Up
- 3 months to end
Family interacting interdependently or
End of Research
(reasons for leaving program may
vary)
Based on tthe
PLM
** Notes:
-Prior to Initial Contact Data has been collected and referral has been made to Coordinators
-Progress within Tiers is determined by level of need of the Families
-Progress may vary – ie. May stay in Tier 1 continuously, may jump from Tier 1 to 3 or Tier 2 back to 1 etc.
-Exit/Entry may vary – may enter at Tier 3 or leave at Tier 2, etc.
-Awareness, Knowledge, Skills and Attitude may be developed/pre-existing at any level
Do these array of Practices, Theories and
Deliverables Constitute a Service Delivery Model?
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How does this framework help us to ensure
intervention fidelity?
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The information void!
Personal Change
Process
Service Integration
Spectrum
Helping Change
Relationship Weighting
Hierarchy Of Needs
Personal Change
Process
Service Integration
Spectrum
Helping Change
Relationship Weighting
Hierarchy Of Needs
The Ecological Perspective
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“The ecological perspective uses ecological
concepts from biology as a metaphor with
which to describe the reciprocity between
persons and their environments… attention
is on the goodness of fit between an
individual or group and the places in which
they live out their lives” (Sands, 2001).
The Ecological Perspective: Brief
History
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In the mid 20th. Century, the Family Systems model was adopted,
that incorporated a perspective that family members are influenced
equally by environmental systems with equal power. This
perspective has been expanded to “explain that an individual is
‘constantly creating, restructuring, and adapting to the environment
as the environment is affecting them’ (Ungar, 2002). The systems
approach now added the social elements to the interactive process.
In the 1960’s and 1970’s, the systems theory was expanded based
on an ecological approach, breaking down the term ‘environment’
into social determinants with varied levels of power and influence,
as deemed by individual stress and need and level of
connectedness. Unlike most behavioural and psychological
theories, ecological theories focus on interrelational transactions
between systems, and stress that all existing elements within an
ecosystem play an equal role in maintaining balance of the whole.”
Systems in Environment:
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Bronfenbrenner (1979), suggests four levels
of ecological components as a useful
framework in understanding how individuals
or family processes are influenced by
hierarchical environmental systems in which
they function: the Microsystem, Mesosystem,
Exosystem and Macrosystem.
The Relationship of the Ecological Model of
Service Integration to the FFE Logic Model:
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Families first is a large and complex project. The logic model itself, which is
usually a visual schematic of a single page, is 17 pages for this project. The 4
overarching goals of the project encompass micro issues related to service
interventions with families and macro issues such as informing policy changes
and research. For any individual in the project, understanding ones role and
relationship in relative to these larger goals can be mind boggling. The
Ecological Model helps the front-line worker to conceptualize and link how their
work at the microsystems level is linked to, and supports the broader goals of
the project.
To be an effective link therefore, the principles encompassed in the model need
to be congruent with the Logic Model. Such congruence can be found in many
parts of the logic model document. For example:
The first page of the logic model has a section called “Statement Of Need”.
This is consistent with the ecological model premise that needs are an
important area of focus for assessing conditions of well-being that the
interventions seek to improve upon.
Relationship Continued:
In the Rationale: Notions of diversity, interconnectedness between families, staff and community; inclusive,
mutually respectful and equitable communities, are all concepts that fit within an ecological model. p.2
The notion of a relationship between “Outputs” and “Activities” that result in “Outcomes” speaks to the need for the
strong capacity of community systems to support the interventions. This again demonstrates the relationship
between private troubles and public issues and the fit for individuals in their environment. Families can not thrive
in a community that doesn’t has the capacity to support them.
“The basic premise of a community-based approach is the recognition that services should be accessible,
continuous, comprehensive, and coordinated…..”p.2 A service delivery model outlines in a conceptual framework
principles that respond to the need to ensure these community based approaches are honored. The coordinated
piece of this, supports intervention fidelity.
“Adequacy of social support is a very important foundation of family adaptation and hence child development”p.3.
This notion of adequacy is linked to the degree of fit between individuals and their environment, which is an
ecological concept.
In The Four Overarching Goals: The logic model outlines four overarching goals that illustrate a
hierarchical conceptualization of systems related to improving upon service integration. The
ecological model places the FMPI intervention at the micro, meso and exosystem levels without
mitigating its interrelationship to the 4th. Goal which is clearly at the macro systems level.
Goals of increased family capacity, sustained collaborations amongst systems stakeholders, improving community
responsiveness to family needs, documenting practices, and informing research, policy and systems, all speak to
an ecological approach to working with the range of issues families face.
Goal 1 and Practices:
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The logic model outlines 1-2, 2-3, and 3-5 year outcomes for families, related to
the goal of families gaining increased capacity to access services. This
suggests a linear progression of change experienced by families.
The logic model describes these outcomes in a manner that reflects increased
awareness, knowledge, skills and changed attitudes of families. The ecological
model provides a visual schematic of this linear progression. This outcomes are
targeted through a experiential learning approach with families and is reflected in
the ‘Personal Change Process’ quadrant of the model schematic.
The logic model also acknowledges the importance of families moving from a
state of dependence, to independence to interdependence with their
environment. Short Term: “family accepts responsibility for some aspect of the
linkage process”; Intermediate: “Family follows up on linkages on their own.
….Family is more connected in their community.” Long-term: “Family
demonstrates sustained ability to apply learned problem solving skills.
….demonstrates increase self-confidence and efficacy.”p.8 These goal
statements are reflected in the ecological model in the ‘Service Integration
Spectrum’ quadrant as well as the ‘Helping Change Relationship Weighting’
quadrant of the model schematic.
What Benefit Does This Ecological
Model Serve To The FFE Project
There are benefits to FFE at 3 levels:
At the front-line worker level: Front-line worker are motivated to do this
work with families, in part because of the value of contributing towards research
and potential outcomes that go beyond working with the family. These same
workers however, may struggle with how their role contributes to the larger
picture. Without this understanding, workers can lose perspective of the
program parameters and lose their motivation to work within these parameters.
At the service delivery level, a model serves the following purposes:
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Provides a contextual framework with which to train workers and support their
work with families.
Clarifies outcomes that the workers practices aim to achieve.
Provides a reference point to start family work and a process and check points
along the way to assess and reflect on this work.
The model can articulate the broader areas of practice domains from where
service delivery strategies are framed.
Front-line Workers Continued:
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The model helps to differentiate an ecological approach from other philosophies that are
perhaps more focused on families as independent units in isolation from their communities.
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Models are value and philosophically based and the ecological model encompasses many
of the practice principles stakeholders felt were important. A conceptual model helps
workers to understand these sets of values and practice principles. (see appendix for
description of theories and principles).
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The model hypothesizes that family needs can change and evolve within a supportive
learning environment, where the degree of engagement and the roles in the reciprocal
relationship between worker and client changes as families move through a spectrum of
empowerment and healthier inter-dependence with their communities. Using an
assessment strategy, this model attempts to measure this change process.
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The model provides the opportunity to measure and inform the change process, providing
the necessary tools for case management and caseload management. Imbedded within
these processes is the notion of Intervention Fidelity, that is, ensuring a consistent quality
and measurable degree of service for families.
Benefits continued:
At the Community Stakeholder Level:
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(including funders, service
delivery partners, etc.)
It provides awareness of the values, practice principles and theories with
which the service providers are operating from and delivery interventions.
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It builds confidence that ‘good practices’ are being incorporated and the
service delivery providers have the necessary knowledge and skill base
to provide services.
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The model provides an opportunity for examination and engagement into
the area of developing innovative practices.
Benefits continued:
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At the Research Level: the conceptual model provides the following:
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Provides the research partners with the broader practice framework that service
delivery is working from.
A broader service delivery framework, described in a conceptual model acts as a
reference point to evaluate the service delivery teams understanding of intervention
goals in relationship to the Logic Model, conceived by a broader set of
stakeholders.
This degree of understanding is important to determine how service delivery
activities will support the outcomes listed in the Logic Model.
The ecological model also helps to clarify disparities in other documents. For
example, the dose of intervention (stipulated in the RFP) appears to be linked to the
notion of linking families to services while the logic model supports practices
associated with a learning process with families that develops their capacities to be
less dependent upon services. This latter service objective is not reflected in the
smaller service doses prescribed and associated simply with linking families to
services. The ecological model to service integration bridges both of these
objectives, dispelling any confusion that service dosage parameters may imply that
capacity building and service integration are some how unrelated concepts.
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What is Intervention Fidelity?
“the adherence and competent delivery of an
intervention by the interventionist as set forth
in the research plan”
Source: Santacroce, Maccarelli & Grey, 2004, p. 63
Components of Intervention Fidelity
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Adherence (or integrity)
The degree to which a given intervention is implemented in
accordance with essential theoretical and procedural aspects of the
model
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Competence
The level of interventionist skill in utilizing core intervention techniques
and responding to the unique needs of each participant
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Differentiation
The theoretical distinctiveness of the model’s main intervention
principles in comparison to those of other models of interest or within
efficacy trials, in comparison to those of competing study conditions
Researcher questions directed at establishing
intervention fidelity for the FFE service integration
practices:
Adherence:
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What are the practices associated with the
awareness, knowledge, skills and attitudes of FFE
service integration?
Are practices implemented consistently?
How do the key elements of FFE appear in the
service integration practices: being family centred,
culturally responsive, building capacity, and reflective
practice?
Researcher questions directed at establishing intervention
fidelity for the FFE service integration practices:
Competence:
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How do the interventionists implement the practices associated with
the awareness, knowledge, skills and attitudes of FFE service
integration?
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How do the interventionists focus on the key elements of FFE service
integration in their work?
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How do the interventionists use their uniqueness in their
implementation of the FFE service integration practices?
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How does Families Matter support the interventionists in their service
integration practices?
Researcher questions directed at establishing intervention
fidelity for the FFE service integration practices:
Differentiation:
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Are each of the FFE service integration vehicles (Family Healthy
Lifestyle and Recreation Coordination Programs) distinct?
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How does Families Matter keep the FFE service integration vehicles
distinct?
What Is Intervention Fidelity in Summary
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Intervention fidelity is about doing what you said you would do.
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Intervention fidelity is about protecting your interventions from influences that can “water
down” or “change” the impact of the intervention.
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A lack of intervention fidelity therefore, makes it hard to determine if the intended
interventions can be attributed to causing the measured outcomes.
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The strength of a randomized control trial is “controlling” the amount and type of
intervention, so that outcomes aren’t attributed to other variables (in-deliberate or
unplanned for activities/influences), which creates “Rival Hypothesis”.

What we want to accomplish is to create as much certainty as possible about which
practices/interventions resulted in which outcomes. Without this certainty, it is difficult to
replicate the interventions. The short coming of some similar studies has been that even
though positive outcomes were noted, the research couldn’t clearly demonstrate the
practices that led to those outcomes, making it difficult to replicate. It also makes it difficult
to confidently be able to generalize the findings to those outside of the study, who we wish
to serve, weakening the impact from a public policy perspective.
Why Is Intervention Fidelity Important?
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Increases the likelihood of an effect for FFE through:
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Internal Validity and the ability to attribute the effect of FFE to the FFE
Interventions.
External Validity and the ability to generalize effects beyond the project
participants
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Increases the validity of findings that helps to answer the original
Research Questions
Supporting Methodology
Increases retention
Increases Confidence of Stakeholders
Replicability/Transferability of FFE
Why Is Intervention Fidelity Important?
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Improves FFE intervention through the discipline of consistent
monitoring and feedback
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Is the foundation of evidence-based practice
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Promotes the avoidance of harm to partners/participants by:
– Improving outcomes
– Increasing the ethical component
– Reducing unintended consequences
– Enhancing reputations/confidence
Replicability Is A Goal Of FFE
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Project 5, FFE Models, Approaches, and
Practices, is a program evaluation that includes
intensive analyses of the implementation of the
different service-delivery models. These analyses
are critical for determining the fidelity and
effectiveness of the service-delivery models, and
also for documenting practices (including
engagement and retention) so that the lessons
learned can be maintained and transferred
(Appendix 1E).Drummond, J.E., Family First Edmonton, Year 1
Research Proposal, p.12b
Importance of Intervention Fidelity

In short, Intervention Fidelity can best be achieved by
ensuring all stakeholders are on the same page. The
logic model as a tool, is the visual schematic that
describes the nuts and bolts of the intervention. As a
process, logic modeling reinforces continuity and
collaboration that supports clarity, reinforces
adherence in the implementation of program
interventions, and the differentiation of different
interventions being tested. (The FFE Logic Model is a
17 page document that does not offer a clear visual
schematic).
Variables Needing To Be Managed To Ensure
Intervention Fidelity
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Human Resource Management
Distinct Programs with Common Practices
Equitable caseload management, ensuring
‘dose’ of intervention, mitigating worker
burden/bias, inconsistent practices, etc.
Consistent practices – data monitoring.
Clarity of outputs and outcomes.
Intervention Fidelity
Adherence & Competence:
Best Practices
3 distinct programs with Common
Practices
The 4 common practice pillars, (principles)
include:
 Family Centered
 Culturally Sensitive
 Reflective Practice
 Capacity Building
Family Centered
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Families First Edmonton supports families in defining
their family, based on their own cultural, religious,
and personal experiences.
The strength-based model focuses on family
capacity and assets rather than deficiencies and
problems.
Family Centered
Working with families from a family centered approach
means different things across the 3 programs.
Challenges are different for each program.
Rec/FHL: it is more challenging to work with families
from a family centered approach within the confines
of the research project for these 2 program areas
Comp: Less challenging because there is more
flexibility to work with families in the areas that they
choose (no need to stay with in ‘rec’ or ‘health’
boundaries
Culturally Sensitive
This area is similar across the 3 service
delivery program areas. Supervisors and
staff use reflective practice in one on one
supervision situations and peer support to
talk about different ways of being culturally
sensitive.
We have received training from our different
partners around cultural sensitivity as well.
Culturally Sensitive – Cont.
Two of our partners (MCHB and Bent Arrow)
who have helped with Cultural Sensitivity
training and practices
Challenges:
 Families needing cultural brokering have
resulted in different timelines
 Staff with different cultural backgrounds
Learnings:
 CPEP Internship Pilot
Reflective Practice
Checking biases- individual biases
With in the different program areas there are
sometimes worker perceptions that families don’t
want to be in a specific program (ie, health) however
it is important to focus on what we do have to offer
(capacity building). Workers need to be able to
have self awareness and check their biases so that
they do not influence the perceptions of the family
negatively
Reflective Practice Cont…
Reflective Practice is used through out the
project:
 by the frontline workers with families,
 in peer support/debriefing,
 by supervisors as a tool to reinforce
consistent practices,
 in case conferences
Capacity Building
Easier to build on the strengths of the family in
comp- doesn’t matter what areas the
strengths are in
All 3 programs work from a capacity building
approach
Practices
These ‘Best Practices’ or Practice Principles
help us to be intentional about our practices
in our work with families and with each
other.
Case Conferencing
Case Conferencing is used by supervisors and staff as
an opportunity for resource sharing and reflective
practice
 Staff present individual cases and then have round
table discussion with whole team about their work
with the family
 Opportunity for all staff to hear what workers have
tried, what has worked/not worked, what resources
are available, how they can be reflective in their work
to ensure that they are approaching difficult
situations from family centered, capacity building
approaches
Training
Training is an important way of ensuring intervention
fidelity across the 3 program areas.
Staggered hire has led to a need to re-create a training
plan. The original training plan did not account for
hiring spread over such a long period of time.
Repeating some training at frequent intervals and have
staff shadow one another have proven to be the
most effective training methods.
Practice Theories
Readiness for Change
Motivational Interviewing
We have done training on both of these
theories and they are consistent with the
Ecological Model for Service Integration and
work well with the idea of flow between
Awareness, Knowledge, Skills, and Attitudes
Intervention Fidelity
…from a TRACKING and DEVELOPMENT
perspective
**the tracking and development area supports
all 3 areas of:
distinction, adherence and competence**
Tracking and Development Variables – Written
Processes and Subjectivity

Variable = Lack of written processes leave staff with no base reference
Implications:

- staff tend to guess or follow another staff’s lead (could be
incorrect).
- can result in the same process entered in different ways
Variable = Subjectivity is a reality with many staff entering in 1 database
Implications:
- data fields and drop down choices can be interpreted in
numerous ways.
- Time is needed to determine methods to out-rule
subjectivity (ie. rating exercises).
- Subjectivity can reduce validity of data
Tracking and Development Variables – Code Book

Variable = Lack of reference to defined terms or a code book attached to the
Database can lead to misinterpretations for both inputs and outputs
Implications:
- data fields and choices to enter in fields (ie. drop
down boxes) can be interpreted in numerous ways
both for input and output of reports.
- a code book should be referenced as to how the field
is defined for data entry.
- When reports are being interpreted, a code book
should be referenced as to what columns each
individualized column means.
- Without these tools, validity of the data is reduced
Tracking and Development Variables – Database
Development and Orientation

Variable = Learning and DEVELOPING the database to the needs of the project
DURING the project can cause inconsistency in data entry and processes
Implications:




extreme amounts of time and resources were required to learn and develop (ie.
customize) the layers of the database.
danger of doing this learning and development as we are already working with
families is the impact on consistency.
large emphasis placed on audits to ensure processes are being used for entry
into the database in a consistent manner
challenge of doing this work ahead of time is knowing what scenarios we would face
with the families.
Tracking and Development Variables – Database
Development and Orientation cont…
Variable = Time in the beginning and at various intervals (due to staggered
hiring process or staff turnover) is required to provide ORIENTATION to staff to
the HOMES database

Implications:
- requires time from supervisors and co-workers to orientate
staff to database…at times may not happen in a timely manner
- multi- layers within database can be overwhelming
- feedback = learn various processes as needed – otherwise
all can be forgotten
- HOMES has numerous navigations to do the same process
which can cause confusion
Tracking and Development Variables – Data Entry –
Timely and Accurate Entry

Variable = Data at times may not be entered in a timely or accurate manner
Implications:
- results in reports being invalid and represents inconsistent
intervention
- impacts reports in such a way that does not represent all
families in study.
- again added emphasis on audits is critical to check for such
variables to data entry and tracking.
Tracking and Development Variables – Data Entry –
Overload

Variable = Amount of information to gather can lead to data not being entered
(missed) into the database (overload)
Implications:
- data missed will not be represented in reports
- checklists have been created to assist staff with
complete data entry
- waiting for information to be uploaded into HOMES
can result in connecting information being missed
(ie. referrals and links, Rec Bank)
**timeliness of entry, accuracy and overload variables are all impacted by caseload
size, amount of data , ease of inputting, checklists for inputting
Hiring and Retaining Staff to Fit
The 3 Program Areas
FHL Staff




Social service background
Focus on connecting to services not
providing the service
Staff must recognize that FHL has a lot to
offer and be able to stay in the program
boundaries to ensure intervention Fidelity
Computer and Administrative Skills
Recreation staff
•
•
•
•
Recreation background and interest
Must be able to stay in boundaries
Computer skills
Additional Administrative burden due to
dollars attached to each child, payments
and tracking
Comprehensive staff
•
•
•
Generally need social services back
ground but also an interest in recreation
(multidiscipline)
Computer skills
Additional administrative burden due to
dollars attached to each child, payments,
tracking etc.
Changes over time

Lots of evenings as demographics of families
changed when criteria changed
–


More working poor and students
Project procedures and tracking evolving and
changing
Training plan based on guiding principles set
up but had to be revised with staggered start
Impact of Evolution of the Project




High staff turn over can impact outcomes
As project evolved the kind of person hired changed
which can have an effect on intervention fidelity
Staggered recruitment of families and staff can
impact caseload management. (higher caseloads,
more new families)
Staggered recruitment of staff which can impact
consistency of processes/data entry
Why The Staff Turnover




Labor market
Big job doing research and service delivery
When project extended there was more staff
turnover
Wages linked to organizational grids versus
market competition
Retaining qualified staff

YMCA
–
–
–



Recognition
Team building
Benefits
Opportunity to get good training and experience
Exposure to community
Opportunity to attend workshops and presentations
Retaining qualified staff cont.

Nurture interest in research
–
–
–
–
Focus groups
Researchers attend meetings
Presentations by CUP
Sense of contributing to the outcomes as well as
service delivery
Maintaining Intervention Fidelity
During Project Close Out

Project has end date unlike many other jobs
therefore well trained staff looking to move to more
permanent jobs
– Surplus from staggered hiring process at start up
used for retention and employment transition
– Impact on intervention fidelity if staff leave before
close out so risk needs to be minimized
– Case load size will decrease but dose must
remain the same cannot spend more than 1 hour
a month or every 3 months, depending upon
program
Complexities Of Articulating A Model







Different Professional Cultures
The question of being Community-based (who owns
what?)
Historical disjointing
Pre empting Research versus the need to meet
Research needs for rigor
Complex Structure
Funding Issues
Time restraints
Learnings:







Research needs to be engaged in the RFP process
Service Delivery needs to be engaged in the planning process but RFP process
doesn’t afford this opportunity
Research and Service Delivery have common work that needs to be well
planned and part of a development phase prior to implementation
Data collection systems need to be well researched and not only funder driven
Inferences made from pilots need to be measured
A logic model and logic modeling process should occur with all “current”
stakeholders to ensure everyone is on the same page and should occur at the
inception of the project
Concepts of Community Based Research need to be clear and support issues
of collaborative capacity development that reflects mutual knowledge sharing
and paraprofessional contributions to the process and learning.
Feedback on Model