Supporting EvidenceBased Family Strengthening Programs to Improve Child Welfare Outcomes

1
Supporting Evidence-Based Family Strengthening
Programs to Improve Child Welfare Outcomes

• A Presentation for 2009 Childrens Bureau
• for Agencies and Courts
• June 4, 2009

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Presentation Goals

• History of our work
• Funders Collaboration -- Alliance for EB Family
  Strengthening Programs
• NC DSS Accomplishments
• Lessons Learned and Key Challenges In Moving
  Toward Successful Implementation of
  Evidence-Based Programs.

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NC Child Welfare System

• The Lay of the Land
• State-supervised, county administered system
• 100 counties, rural with 3 large urban centers
• Continuum of services from primary prevention
  through adoption
• Having more evidence-based family strengthening
  programs is critical issue in improving CFSR
  outcomes in NC

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Why More Evidence-Based Family Strengthening
Programs?

• Changing parental behavior either to prevent
  families from coming into system or to move them
  out of system safely (and keep them out!) is
  our key challenge.
• State of the State
• Little funding systematically provided across the
  state to address this challenge
• As a result, few skills-based parenting programs
  exist
• What does exist, typically hasnt been evaluated
• Those research-based programs that do exist, do
  so in pockets across state. No continuity,
  large-scale momentum, or cost-efficiencies in
  implementation.

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So What to Do?

• In 1995, NCDSS was part of a statewide Task Force
  on Child Abuse Prevention co-convened by PCA and
  NCIOM
• Recommendations focused on more replication of
  evidence-based family strengthening programs
  which NCDSS took very seriously and committed to
  moving towards with its funding
• Participated in an Expert Work Group convened
  by PCA and Duke University to look at
  implementing these recommendations
• First study looked at capacity issues of family
  resource centers in implementing evidence-based
  programs and recommendations for facilitating
  that transition

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Our Accomplishments

• Expert Work Group morphed into Alliance for
  Evidence-Based Family Strengthening Programs
• Group of public-private funders that
  collaboratively support the implementation of
  select evidence-based programs
• In collaboration with Alliance
• Changed RFA process to prioritize funding for
  evidence-based/promising programs
• Changed legislation of state funding to ensure
  funding used for evidence-based/promising
  programs
• Supporting state-level infrastructure for 3
  programs Incredible Years, Strengthening
  Families Program, Circle of Parents
• Creating linkages between early childhood
  initiative, juvenile justice, child welfare,
  public health to leverage funding for
  evidence-based programs

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The Alliance

• Key assumptions about successfully implementing
  evidence-based programs
• Key principles of the Alliance
• Who is involved
• How it works
• Future Directions

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Getting Better Results, Part I

• We use untested medical protocols in this
  clinic, but we are confident that they work.
• What are the practices and programs being
  implemented?
• Have they been rigorously evaluated and
  implemented in community settings with
  consistently positive outcomes?
• Fair amount of research on what works program
  registries, lists of proven practices, etc.
• BUTchoosing a program off a list isnt enough.

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Getting Better Results, Part II

• We use vaccines proven to prevent childhood
  diseases in this clinic, and we water them down
  so we can serve more children.
• How are evidence-based programs practices being
  implemented?
• Implemented with fidelity to the program
  standards.
• Emerging research on implementation drivers or
  the key ingredients for effectiveness
• Proven practice fidelity/quality Better
  Results

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What Are Key Ingredients for Successful
Implementation?

• The spray and pray approach doesnt work.
• Assistance with community and agency planning
• Staff Selection
• Pre-Service and In-Service Trainings
• Ongoing Consultation and Coaching
• Program Evaluation Technical Assistance
• Quality Assurance Technical Assistance

See National Implementation Research Network
for full review.
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Important Questions for NC

• What are the programs/practices being delivered
  to children and families in North Carolina?
• AND
• If programs are proven, how are they being
  delivered to children and families in North
  Carolina -- with the key ingredients for
  effectiveness?
• AND
• As funders and advocates who want better results
  for children and families, how are we supporting
  community-based agencies in accessing the key
  ingredients of effectiveness?

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The Alliance

• Collaborative group of public and private
  organizations/agencies that fund family
  strengthening programs to improve a range of
  outcomes for children and their families
• Goal is to collaboratively support successful
  implementation of evidence-based programs.

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Who Participates in the Alliance?

• Current Membership NCPC, NCDPH, NCDSS,
  NCDMH/DD/SAS, Childrens Trust Fund, Head Start,
  Governors Crime Commission, The Duke Endowment,
  Kate B. Reynolds Charitable Trust
• Staffed by PCA North Carolina and the Center for
  Child and Family Policy, Duke University.

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Key Premises of the Alliance

• When we invest wisely in proven programs that
  promote optimal child development, the next
  generation will pay back the investment as
  productive and responsible citizens.
• Evidence-based programs often result in better
  outcomes across multiple domains (child abuse
  prevention, school readiness, substance abuse
  prevention, violence prevention, etc.).

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Key Premises of the Alliance

• Communities and agencies need access to
  scaffolding -- ongoing training,
  coaching/technical assistance and program
  evaluation -- to deliver evidence-based programs
  successfully.
• Funders can best advance the replication of
  proven programs by working together, across
  funding streams, to collaboratively support and
  sustain programs we know produce the best
  outcomes for children and their families.

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ALLIANCE LOGIC MODEL
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Alliance Collaboration Table

• Alliance members agree program meets number of
  criteria (evidence-based, replicable, etc.) and
  target the Alliances shared intermediate
  outcomes
• Alliance members agree to fund local agencies to
  implement these programs (as appropriate)
• Collaboratively build and fund state-level
  scaffolding (as needed) to support implementation
  of these programs

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Alliance Collaboration Table

• Nurse-Family Partnership
• Incredible Years
• Strengthening Families (limited scaffolding)

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Healthier Pregnancies and Improved Birth Outcomes
Public Health
Decreased maternal smoking
Decreased reports of child abuse
Social Services
Improved parenting skills
Nurse-Family Partnership
Improved school readiness
Early Childhood Development
Economy
Increased workforce participation
Less youth involvement in juvenile system
Juvenile Justice
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Stronger parent-child relationships
Social Services
Improved parenting skills
Early Childhood Development
Improved school readiness
Incredible Years
Decrease in conduct disorders leading to juvenile
aggression/violence
Juvenile Justice
Education
Increased family involvement and parent/school
relationship
Mental Health
Improved child mental health
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Alliance Collaboration Table

• Nurse-Family Partnership
• 7 year commitment from Alliance funders (TDE,
  KBR, DPH) BC/BS
• 8 sites in 10 counties
• Goal available statewide
• Preparing for Federal Funding (hopefully!)
• Significant scaffolding available at national
  level through NSO. At state level, NFP Statewide
  Coordinator currently housed with PCANC and
  developing plan for state-level infrastructure.

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Alliance Collaboration Table

• Incredible Years
• 13 sites funded by Alliance members (and some
  funders outside of Alliance)
• State level scaffolding DSS, TDE
• Local level funding Smart State, DSS, DPH,
  other
• IY Coordinator (organizational readiness) and IY
  Coach (fidelity/quality assurance) on PCANC staff
• Serve ANY site in North Carolina (regardless of
  who funds locally)

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Working Together for Better Results

• Through collaboration of public and private
  funders
• One portal of entry for any agency/community that
  is interested in replicating an
  Alliance-sponsored program
• Common tools to assess agency and community
  readiness for implementing the program
• Set of implementation guidelines that all
  funders agree to uphold (e.g., fidelity
  requirements)
• One evaluation process and set of tools (in
  process)

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Better Results

• Increased replication of specific evidence-based
  programs
• More effective implementation with fidelity
  better results for kids and family
• Increased efficiencies one set of tools, staff
  providing technical assistance,
  implementation/fidelity guidelines across
  agencies
• Easier for communities to implement an
  evidence-based program

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Lessons Learned Key Challenges

• The formula is the foundation of our work
• Proven practice fidelity/quality Better
  Results
• The critical question facing the field is HOW we
  provide implementation support to local
  programs.
• Identifying shared outcomes across funding
  streams/agencies is CRITICAL to supporting shared
  investment in programs.
• Given what we know about implementation from
  NIRN, we believe funders need to fund
  infrastructure for implementation support for
  local communities
• Given the amount of resources it takes to support
  implementation, we dont think we will be able to
  fund dozens of different family strengthening
  programs.
• We are going to have to move from let a thousand
  flowers bloom to building a system with a few
  key programs serving as anchors with sufficient
  supports for implementation/fidelity

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Contact info

• Charisse Johnson, Section Chief
• Child Welfare Services
• NC Division of Social Services
• Charisse.johnson_at_ncmail.net
• [phone]
• Michelle Hughes, MA, MSW
• Vice-President for Programs
• Prevent Child Abuse North Carolina
• mhughes_at_preventchildabusenc.org
• [phone]