Outcomes of Peer Supervision across Multiple EBPs within a Community Setting
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1 Outcomes of Peer Supervision across Multiple EBPs within a Community Setting 2011 Children s Mental Health Research and Policy Conference Dr. Susan Stern, Associate Professor 1 Dr. Sandra Cunning, Director Research and Evaluation 2 Dr. Jonathan Golden, Clinical Director Community Mental Health 2 University of Toronto 1, Kinark Child and Family Services 2
2 Overview Kinark s Agency Profile Clinical Transformation Fidelity and Supervision Clinical Supervision Model Peer Supervision Results Collaborative Research Partnership Discussion
3 Kinark s Agency Profile
4 Agency Profile Kinark Child and Family Services: Multi-Site, geographically dispersed Operate in Central East and Central West Ontario Multi-service, multiple programs: Youth Justice Children s Mental Health Autism Supervised Access Child care Over 850 employees volunteers
5 Clinical Transformation
6 Clinical Transformation Process: A multi-year, agency-wide process 4-year change process; started 2006 National Implementation Research Network Evidence-Based Model of Implementation ( 2009) Involves working groups, installation teams, implementation teams
7 Clinical Transformation Goals: Successful implementation of consistent, sound clinical practice based on evidence-based practices (EBPs) throughout Agency Measurable improvements in client outcomes Contributions to science: Practice Implementation EBPs Improved efficiency and effectiveness of clinical practice
8 Clinical Transformation The Evidence-based Change Model: Effective intervention practices + Effective implementation practices = GOOD OUTCOMES FOR CHILDREN AND FAMILIES
9 Clinical Transformation Implementation Stages Exploration: Working Groups The process through which potential EBPs are determined. Installation: Installation Teams These teams develop the initial implementation plans. Implementation: Implementation Teams This process is the link between planning and operationalizing. These teams refine initial plans and manage the implementation. Innovation Research and Evaluation, in partnership with other institutions and partners will provide support for innovations. Sustainability The process is demonstrating that ongoing changes in all support systems need to occur to ensure sustainability. Training and education processes, clinical supervision processes, data collection processes, HR and finance processes support the practices.
10 Clinical Transformation STAFF PERFORMANCE EVALUATION CONSULTATION & COACHING DECISION SUPPORT DATA SYSTEMS INTEGRATED & COMPENSATORY PRESERVICE TRAINING SYSTEMS INTERVENTIONS RECRUITMENT AND SELECTION Fixsen, D. et al. (2007)
11 Clinical Transformation Objectives Rationale Intervention & Population Activities & Outputs Client: Improved functioning Satisfaction Staff: Experience of intervention Intervention: High fidelity to practice Service: Improved resource allocation Services matched to needs, capacities Theory: Theory/ background of selected EBPs Services Reviewed: Review of other services or agencies using particular EBP Principles: Evidence-based Client-focused Competency based Evidence informed Minimally sufficient Collaborative Inter-disciplinary Clinically supervised Intervention: The nature of the intervention (e.g., individual, group, parent education etc.) Population: The specific population for the intervention Reflects the specific client clinical need Activities: All the specific activities involved in delivery of the intervention (e.g., 16 week group session) Outputs: All deliverables of the intervention (e.g., number of group sessions, attendance, posters, phone calls, number of interviews, manuals etc.)
12 Fidelity to Practice
13 Fidelity to Practice Fidelity is: Adherence: Program components and processes Competence: Skillfull implementation of program components and processes Supported by clinical, training, supervisory practices Fit to client context (i.e., need, strengths, values) Differentiation: Discrimination between different EBPs and between EBPs and TAU AND Common Elements: Identification of shared practice strategies and change mechanisms across EBPs.
14 Fidelity to Practice Modification of efficacious treatment compromises effectiveness Local context: adapting EBPs to diverse client, community and cultural contexts Tension between adherence and flexibility Flexibility within fidelity Client Diversity Therapeutic Alliance Significant challenges to implementing EBPs in community practice Need to provide the critical supports Ongoing dialogue
15 Fidelity to Practice MST Expert consultation and monitoring, MST Institute training/continuous quality assurance arm Triple P Provider implemented self-regulatory framework Implemented within a peer supervision model Solution-Focused Brief Therapy (SFBT) Setting positive supervisory goals Exploring the exceptions of supervisees and clients Giving feedback and clinical education (Wei-Su, 2009)
16 Fidelity to Practice Rationale Scant research on supervision Evidence (MST) that adherence to structure and process and focus on clinician development predicts improved outcomes (Schoenwald et al., 2009) Links between consultation, supervision, therapist adherence, youth outcomes Supervision (SFBT) contributes to clinician self-efficacy (Koob, 2011) Systematized lessons learned (Triple P): promoting fidelity, promoting flexibility (Mazzucchelli & Sanders, 2010)
17 Fidelity to Practice 1. Implementing a common measure 2. Testing the measure 3. Examine differences and similarities among EBPs 4. Examining the relationship between fidelity and client experience and outcomes 5. Describing systematic changes over time
18 Clinical Supervision at Kinark
19 Clinical Supervision at Kinark Clinical Supervision - key to sound, clinical practice Enhances quality and fidelity Promotes consistency in the supervisory process Clinical Supervision - the cornerstone of EBP Ensures alignment between client goals and EBPs Increases the alignment between therapist clinical and theoretical approach with the EBP ( ownership )
20 Kinark Clinical Supervision Structural Framework Director, Clinical Services Clinical Directors Provide clinical supervision for Autism, CMH, YJ Program Director Associate Clinical Directors Local & Cross Agency Peer Consultation EBP Practice Leader Clinical expert who: Provides consultation to the CSS & EBP Practitioners Is responsible for EBP fidelity Client Service Supervisor (CSS) Provides clinical & managerial supervision to direct service practitioners EBP Peer Coach Accessible daily EBP support Structure may vary by EBP Direct Service Practitioner Direct Service Practitioner Direct Service Practitioner (Falendar, 2004; Hawkins & Shohet, 1985, 2000; Shulman, 2009) Legend: Supervisory = Advisory =
21 Peer Supervision Feedback
22 Peer Supervision Peer Supervision process Quarterly feedback across processes and EBPs Lead by practice lead Supported by Associate Clinical Directors Evaluated
23 Peer Suupervision Peer Supervision Measure: Dimensions Group Environment Creating a supportive & collaborative peer learning community Providing a mechanism for quality assurance (i.e., fidelity) Skill Development Developing competence in EBPs Enhancing clinical skills (general and client-focused) Professional Outcomes Fostering self-directed learning Enhancing self-regulation and self-efficacy Enhancing personal accountability of practice (i.e., using evidence and achieving outcomes)
24 Peer Supervision Sample Group Environment 1. The group worked in a collaborative manner Skill Development 1. Role playing/behavioural rehearsal of skills was encouraged Professional Outcomes 1. Increased my confidence in my ability to use the EBP Strongly Strongly Disagree Agree NA Disagree Agree Strongly Strongly Disagree Agree NA Disagree Agree Strongly Strongly Disagree Agree NA Disagree Agree
25 Peer Supervision Peer Feedback Completion Rates by Session and EBP 90.0 Percentage of Participants New Practice Lead DirectResponse SFBT Clinical Session Number
26 Peer Supervision Level of Agreement "Supportive & Collegial" by Type of Triple P at 1st Session Percentage of Respondents Primary Group Individual 0.0 NA Strongly Disagree Disagree Agree Strongly Agree Rating
27 Peer Supervision Level of Agreement "Materials Used Effectively" by Type of Triple P at 1st Session Percentage of Respondents Primary Group Individual 0.0 NA Strongly Disagree Disagree Agree Strongly Agree Rating
28 Peer Supervision Level of Agreement "Increased Confidence my Work is Helping My Clients" by Type of Triple P at 1st Session Percentage of Respondents Primary Group Individual 0.0 NA Strongly Disagree Disagree Agree Strongly Agree Rating
29 Peer Supervision Percentage of Particpants in SFBT Indicating "My Goals for this Meeting were Met" Percentage of Participants New Practice Lead Goals Meet Session Number
30 Summary & Discussion
31 University-Community Partnership: Redefining Roles and Needs of Partners + Trust and Respect = GOOD OUTCOMES FOR CHILDREN AND FAMILIES
32 Contact Info Sandra Cunning, Ph.D., Director, Research & Evaluation Dr. Susan Stern Associate Professor Kinark Child and Family Services, 500 Hood Rd., Suite 200 Markham, ON L3R 9Z3 Factor-Inwentash 246 Bloor Street West Toronto, ON, M5S 1V4 Phone: ext. 497 Fax: Phone: Fax:
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