Learning Session 2

Day 1October 16th, 2019

Welcome/Opening Remarks

Jennifer Leonardo, PhD, MSW, LCSWChildren’s Safety Network, Director

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Technical Tips

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Call (866) 835-7973 to listen and be heard

Download resources in the File Share pod (above the slides)

Mute yourself when you’re not talking (use phone’s mute button or press *#)

This session is being recorded

Use the chat (bottom left) to ask questions at any time

This webinar is subject to the CSLC data agreement*

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Jenny Stern-CarusoneAssociate Director

Jennifer LeonardoDirector

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Maureen PerkinsProject Officer, HRSA

Jerry ReedChildren’s Safety Now Alliance Co-Chair

Bethany MillerProject Officer, HRSA

Children’s Safety Network Leadership

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Keri LemoineProject Coordinator

Kate SinclairResearch Assistant

Children’s Safety Network Staff

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Maria KatradisCSLC Co-Manager

Jim VetterCSLC Co-Manager

Bina AliResearch Scientist

Erin FickerCSLC Co-Manager

Cindy RodgersTechnical Assistance

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Welcome Jennifer Leonardo, CSN DirectorMaureen Perkins, HRSA Project Officer

Where We Are as a Collaborative Jim Vetter, CSLC Co-Manager

Team present storyboard IA Bullying Prevention

Accelerating Improvement: From Developing to Testing, Implementing, and Spread

Jennifer Leonardo, CSN Director

Team present storyboard PA Sudden Unexpected Infant Death Prevention

Homework assignment/Wrap Up Erin Ficker, CSLC Co-ManagerJenny Stern-Carusone, CSN Associate Director

Teams Work on their own/Homework TEAMS MEET ON THEIR OWN

Day 1

All Teach

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All Learn

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To Advance the Field of Injury and Violence Prevention

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Opening Remarks from HRSA

Maureen Perkins, Public Health Analyst, Injury & Violence Prevention ProgramsHRSA, Maternal and Child Health Bureau

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Where We Are as a Collaborative

Jim Vetter, EdMCSLC Co-Manager

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Participating States

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Priority Injury Topics

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Bullying Prevention Motor Vehicle Traffic Safety Poisoning Prevention

Sudden Unexpected Infant Death Prevention

Suicide and Self-Harm Prevention

CSLC Cohort 1 Highlights So Far•individuals received education on PP and SUIDP7,957•parents and caregivers in underserved, at risk communities that

received evidence-based safe-sleep education6,000•organizations distributing child safety seats and booster seats638•schools and organizations using evidence-based programs (BP,

MVTS, SSHP, SUIDP)381•child passenger safety technicians trained and certified315•schools increased access to evidence-based programs315•organizations that distribute free or discounted Pack n’ Plays214

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CSLC Cohort 1 Highlights So Far•hospital and birthing facilities provide infant safe sleep training

to parents/caregivers118•schools and organizations conducting teen driver safety

programs with teens91•hospital and birthing facilities provide infant safe sleep training

to health care providers81•schools and organizations providing gatekeeper training 69•child passenger safety inspection and fitting stations established64•schools and organizations providing evidence-based multi-

component suicide and self-harm prevention programs20

“It forced our team to get on the same page about current status and next steps, which made us realize that we need to make more frequent meetings outside of the CSLC topic calls. Coordinating between two agencies is a challenge!”

What the States Are Saying about the CSLC

“This whole process is helping me understand & utilize the public health side more effectively.”

“I will keep moving the project forward. It was interesting to keep hearing about other teams because I hope to reach out and draw on their experiences also.”

“Great webinar with great speakers. Use tools to learn how to get stakeholders' engagement. Love the idea of using youth for ambassadors and advisors.”

“The visual aspect of the poster boards allowed for recognizing progress in a way that talking does not easily do. I really appreciated being able to see it!”

What the States Are Saying about the CSLC

“It was nice to see what other states are focusing on and their potential strategies to "get going" on their action steps.”

“How well facilitated these sessions are -- to serve professionals from multiple states working on this issue

“The educational info on the planning tools were good review.”

Multiple states implementing same evidence-informed strategies

and sharing their insights for increased peer learning

Achievements

Child Safety Expertise

Leadership and

ManagementSystems

Improvement

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QI Innovative and expanded partnerships across state systems and between public, private and non-profit organizations

Use of quality improvement tools and concepts to organize, assess and drive work to achieve results

Quality Improvement

Share Your Successes!

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What has your topic team accomplished since the beginning of the Learning Collaborative?

Child Safety Expertise

Leadership and

Management

Systems Improvement

Use of effective leadership and management approaches

Use of evidence-based and evidence-informed strategies

Use of quality improvement tools and concepts

Bullying PreventionStoryboard Presentation

Melissa Ellis, Iowa20

Facilitator: Jim Vetter, BP Topic Lead

Iowa Bullying Prevention Project

Melissa EllisTitle V Bullying Prevention Coordinator

Iowa Department of Public Health, Bureau of Family Health

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Aim Statement Reduce bullying victimization among children and adolescents by building and improving partnerships and implementing evidence based bullying prevention strategies, especially among the most vulnerable populations.

According to the website www.stopbullying.gov, “Bullying puts youth at increased risk for depression, suicidal ideation, misuse of drugs and alcohol, risky sexual behavior, and can affect academics as well. For LGBTQ youth, that risk is even higher.”

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Partnerships Goals

Engage Stakeholders

• Partnership between State Title V Program and Iowa Safe Schools ◦ Iowa Safe Schools comprehensive

support, victim services, resources, and events for LGBTQ and Allied youth. Serving over 4,500 youth annually, Iowa Safe Schools is the largest LGBTQ youth serving organization in the Midwest

◦ Entered into a contractual agreement to assist in facilitating student focus groups for college age, high school age, and middle school age Gay Straight Alliances (GSA’s)

• Implement the use of inclusive curricula and establish student groups for youth at increased risk of bullying victimization and/or perpetration (e.g., Gay Straight Alliances) to encourage values of respect, inclusiveness, and safety within school environments

(Bullying Prevention Change Package CSLC)

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Youth Voice

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Student Input

Focus groups

CSLC TA Request for

Curricula

IDPH/Iowa Safe Schools select

curricula together

Pilot Curricula with GSA

students at camp

Types of Bullying? “Cyber bullying is more common than real life bullying”

What is bullying? “We no longer have PowerPoint presentations on it (bullying). There aren’t bullying posters anymore, there are now mental health posters.”

Where do you get your messaging? “If teachers had to report everything they hear they wouldn’t even have time to teach us.”

Next Steps

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What Remains Priority

•Student input•Importance of youth voice in

programming •Students are the experts in what

they need to feel safe and supported in their community and school

•Programming should reflect the needs of the population you serve

Adjust

•Utilize data from Pride Camp •Engage students to participate in

future program planning •Make adjustments to presentation

of Lifeguard Workshop if needed•Implement Lifeguard Workshop

this school year in several Des Moines metro area schools

•Capture data from program pre and post tests

Accelerating Improvement: From Developing to Testing, Implementing, and Spread

Jennifer Leonardo, PhD, MSWChildren’s Safety Network, Director

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Workforce development

Leadership and

management

Systems improvement

Child safety expertise

Improvedinjury andviolence

preventionsystems

Positivehealthimpact

Outputs

What Is Improvement and How Do We Get There?

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Systems Improvement: Phases of Improvement

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Develop•Theory

and Prediction

Test•Test under a

variety of conditions

Implement•Make part of

routine operations

Spread•Sustaining

and spreading to other locations

Develop

What challenges are you facing, or did you face, in this phase of improvement?

Develop: Getting Ready

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• Conduct a needs assessment• Form an implementation team• Complete a systems map as a team• Select child safety strategies and measures• Set up partnerships• Build data management systems• Develop resources and secure materials• Identify and engage pilot sites

Test

What challenges are you facing, or did you face, in this phase of improvement?

Test: Not Every Change Is An Improvement

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• Decide on one of more change and sequence changes

• Start small

• Test widely

• Collect data

• Make adaptations

• Evaluate cost implications

• Increase degree of belief that change will lead to improvement

Test: Start Small

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Multiple Cycles• Build partnerships• Contextualize• Learn

Proposals, Theories, Ideas

High Degree of Belief that Changes Result in

Improvement

A PS D

A PS D

D SP A

1 school

5 district schools

APS

D

Implement

What challenges are you facing, or did you face, in this phase of improvement?

A Few Considerations Before Implementation

• Plan on it taking more time and effort than testing

• Changes now becomes part of routine day-to-day operations in your pilot population • Don’t expect failure here• More people impacted than during testing• Increased resistance

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Implement: It’s All About Sustainability

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• Develop training and new hire training• Update job descriptions• Update or develop policies and procedures• Improve communication• Purchase equipment• Standardize work and work flow

Spread

What challenges are you facing, or did you face, in this phase of improvement?

Spread: Going To Scale

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• Identify a champion• Identify partners• Develop a communications strategy• Develop a measurement plan • Put structures and feedback systems into

place• You are still testing and implementing as you

spread*

Spread: Taking The Improvements to Scale

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Set-up• Adopter audiences• Successful sites• Key partners• Infrastructure supports to

enable adoption• Initial spread strategy

(leverage system structure)

Knowledge Management

Measurement and Feedback

Leadership• Topic is a key strategic initiative• Goals and incentives/policies aligned• Executive sponsor assigned• Day-to-day managers identified• Aim developed

Better Ideas• Develop the case • Describe the ideas

Social System• Early adopters• Key messengers • Communities• Technical support• Transition issues

IHI.org http://www.ihi.org/resources/Pages/IHIWhitePapers/AFrameworkforSpreadWhitePaper.aspx

Facing Challenges Together

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Child Safety Expertise

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• What is “evidence?”• What are the best practices?• Which practices are better for our context?

Develop•Theory

and Prediction

Test•Test under a

variety of conditions

Implement•Make part

of routine operations

Spread•Sustaining

and spreading to other locations

Leadership and Management

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• How do we engage senior leadership?• Who are the right partners?• How do we keep partners engaged?• How do we lead our implementation

team?• How do we lead our pilot sites?

Develop•Theory

and Prediction

Test•Test under a

variety of conditions

Implement•Make part

of routine operations

Spread•Sustaining

and spreading to other locations

Leadership and Management: Psychology of Change

44IHI.org White Paper The Psychology of Change Framework

Leadership and MANAGEMENT

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• What are our timelines?• How do we get the work done with limited time and

resources? • How do we keep everyone aligned?

Develop•Theory

and Prediction

Test•Test under a

variety of conditions

Implement•Make part

of routine operations

Spread•Sustaining

and spreading to other locations

Systems Improvement

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• What if we think we are ready to spread?• Do we really need to keep running PDSAs?• What kind of data do we need, how much, and for how long?

Develop•Theory

and Prediction

Test•Test under a

variety of conditions

Implement•Make part

of routine operations

Spread•Sustaining

and spreading to other locations

Questions?

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Sudden Unexpected Infant Death PreventionStoryboard Presentation

Josh Goodling, PA48

Facilitator: Erin Ficker, SUIDP Topic Lead

Sudden Unexpected Infant Death Prevention

(SUIDP)

PA SUIDP Strategy Team

Elizabeth Dunlevey, Injury and Violence Prevention DirectorJoshua Goodling, SUIDP Primary Point of ContactErin McCarty, Director, Division of Bureau OperationsChristina Phillips, Public Health Program AdministratorAngelo Santore, Public Health Program ManagerTara Trego, Bureau Director, Family Health

The PA SUIDP Strategy Team is working to reduce the number of SUID deaths across a variety of change ideas. 49

Aim Statement

• Collaborate with the CSLC and other states to gather ideas, learn strategies, and receive feedback to improve Safe Sleep programs and implement processes that will allow PA DOH to reduce fatal and serious injuries among infants.

• Implement new quality improvement and program improvement methods to better shape Safe Sleep programs to meet Title V State Action Plan goals and lower SUID related deaths.

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Measurement

• Increase the statewide percentage of birthing hospitals implementing our model safe sleep program.

• Increase the statewide percentage of infants born in birthing hospitals implementing our model safe sleep program.

• Process measure data are reported quarterly and annually rates are created to determine program impact and trends.

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Process Measures & Goals

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Process Measure Goal Progress

1. # of hospitals and birthing facilities providing infant sleep training to health care providers.

Six per year Process measure data is collected quarterly.The grantee is on target to achieve goals.

2. # of hospitals and birthing facilities providing infant safe sleep education to parents/caregivers.

Six per year Process measure data is collected quarterly.The grantee is on target to achieve goals.

4. # of infants in underserved, at-risk communities that receive evidence-based safe sleep education.

All well newborns at participating hospitals

Process measure data is collected quarterly.The grantee is on target to achieve goals.

Process Measures & Goals

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Process Measure Goal Progress7. # of organizations implementing and/or spreading evidence-based infant safe sleep campaigns

One Process measure data is being collected from our grantee on the various components of their social marketing plan.

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• PA’s work within the CSLC is linked to its Title V priorities, Action Plan and current programming work.

• Through participation in the CSLC, PA is also looking to strengthen the evidence base to support our programming.

• The SUIDP team is currently comprised of program administrators working in these program areas across two divisions within the DOH.

• PA has identified and begun tracking process measures where current data are available.

Organizing The Work

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Partnership

• A study showing increased adherence to safe sleep practices in the hospital setting when a bundled intervention was implemented at room orientation rather than hospital discharge prompted the PA DOH to support development of such a model program.

• PA DOH partnered with the University of Pennsylvania to develop and implement a hospital based model program.

• After successful implementation at two Philadelphia hospitals PA DOH is monitoring and collecting data relating to the process measures.

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Lessons LearnedWe planned We found We think

We planned on a linear constant implementation for provider and family education

Due to other priorities and changing leadership and/or ownership the process was not always linear and constant.

We have adjusted the timeline and expectations for implementation to match the realities.

We planned on monthly data collection and reporting

Due to program reporting we found that it is easiest to collect data quarterly.

We have adjusted our process measures and the data to be collected quarterly.

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Continue to…• Schedule CSLC meetings every month to provide updates, brainstorm,

and improve processes.

• Schedule “mini CSLC” meetings to update progress and focus on strategies and change ideas.

• Smaller workgroup meetings allow for more involvement and better development of goals.

• Participate in scheduled CSLC topic calls.

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Our next steps…

• Continue implementing PDSA cycles, and start smaller PDSA cycles.

• Continue collecting available process measure data.

• Continue to support the University of Pennsylvania with the recruitment and implementation of their safe sleep program.

Homework Assignment

Erin Ficker, CSLC Co-Manager

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Reflection

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Where are you in your improvement journey? Develop? Test? Implement? Spread?

Improvement Checklist

Develop

Test

Implement

Spread

Key elements

Activities

Status

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Improvement Checklist

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Improvement Checklist

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Improvement Checklist

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Improvement Checklist

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Improvement Checklist

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Improvement Checklist

Homework

Working with you team, consider one of your child safety strategies and work through the improvement check list.

1. Consider where you are in the process

2. Review prior elements, mark as complete, and list the associated activities

3. For current and future elements, consider where you are and the associated activities necessary to complete this element.

4. Be prepared to share your check list and insights gained through the process.

Questions?

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Please enter your questions in the Q & A pod

Team time for homework. See you tomorrow!

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Day 2 Welcome and Recap of Day 1 Jennifer Leonardo, Director

Review homework highlights Erin Ficker, CSLC Co-Manager

Team Present storyboard LA Suicide and Self-Harm Prevention

Using Data Effectively Maria Katradis, CSLC Co-Manager & Data Manager

Team Present storyboard IA Poisoning Prevention

Team Present storyboard WA Motor Vehicle Traffic Safety

Closing Remarks and Next Steps Jenny Stern-Carusone, Associate Director

Thank you!

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Visit our website:www.ChildrensSafetyNetwork.org

Please fill out our evaluation.

To request technical assistance, please fill out our TA Request Form.

Funding SponsorThis project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Child and Adolescent Injury and Violence Prevention Resource Centers Cooperative Agreement (U49MC28422) for $5,000,000 with 0 percent financed with non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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