Ontario’s Special Needs Strategy:

Integrated Delivery of Rehabilitation

Services

Spotlight Series Webinar on Change Management

July 29, 2016

Toll-Free: 1-855-340-1607 Conference ID: 3134031#

Webinar Link:

https://opsevents.webex.com/opsevents/onstage/g.php?MTID=ee0bddf2c58f4a3704

970a13f82d3271e

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Overview

1. Describe the approach used to change practice using

Partnering for Change as an example

2. To support a discussion amongst members of the local

Steering Committees/Proposal Development Tables

about their experiences in managing change through

their local processes

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The Reality of Change

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Frameworks for Managing Change

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The Change Process

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Exploration

Installation

Initial Implementation

Full Implementation

Sustained Implementation

Ghate, Deborah. (2015). From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families, Journal of Clinical Child & Adolescent Psychology, 00:1-15. Retrieved April 1, 2016 from http://dx.doi.org/10.1080/15374416.2015.1077449

Two to four years from exploration to full implementation

Debra Stewart

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D E B R A S T E W A R T , M S C . O T R E G . ( O N T . )

S C I E N T I S T , C A N C H I L D C E N T R E F O R

C H I L D H O O D D I S A B I L I T Y R E S E A R C H ,

M C M A S T E R U N I V E R S I T Y , H A M I L T O N , O N

LESSONS LEARNED ABOUT

CHANGE MANAGEMENT AND TRANSFORMATION OF

SCHOOL-BASED REHABILITATION SERVICES

PARTNERING FOR CHANGE PROJECTS

• “Partnering for Change” is a model that was first

developed by CanChild researchers, leaders from

the Central West CCAC, and many other

stakeholders to address the inequity and escalating

needs of children with Developmental Coordination

Disorder (DCD)

• Pilot project 2008-09

• Demonstration project 2009-11

• Knowledge translation project 2011-12

• Implementation and Evaluation project 2013-15

SPECIAL NEEDS STRATEGY: INTEGRATED REHABILITATION SERVICES

• Implementation of a new service model for children

with special needs in Ontario – an integrated

approach involving three professions

• Transformation from traditional preschool and

school health services to a tiered model of

capacity-building in children’s natural contexts –

requires significant change at all levels

Provides a framework to get started and throughout an implementation Guides you to identify factors and strategies to consider, and their interactions

IMPLEMENTATION SCIENCE

FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)

Start with the Environment

• The ‘traditional’ model of

service delivery will create

barriers at first for

implementation of a tiered

model

• Preparing the stakeholders

and the organizational structures will greatly

enhance the implementation

of the new intervention

THE INTERVENTION:

A TIERED MODEL FOR IRS

• Essential for some

• E.g., one-on-one intervention

Tier 3

Individualized

Services

•Necessary for many

•E.g., small group intervention, parent/caregiver training, parent consultation

Tier 2

Targeted Services

•Beneficial for all •No formal intake/assessment

•E.g., collaborative consultation, early years setting/classroom/school strategies

Tier 1

Universal Services

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FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)

Stakeholder perceptions,

characteristics and actions

• a range of reactions and

actions

• include all stakeholders in

implementation activities

and decisions

• educate/inform everyone

• be prepared to manage

conflict

FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)

Organizational Structures

• current structures and systems

need to be changed:

- billing and data collection systems

- organization of therapists’ time in

schools, and payment

- ‘caseload’ vs. ‘workload’ measurement

• allow time for therapists to start

implementing the tiered

approach in schools before

‘releasing’ wait lists

“IT’S A HUGE TRANSFORMATION”

•Multiple systems, services and people are involved in this change

• Be prepared for complexity

• Transformation takes time

Planned change management

is needed

CHANGE/TRANSFORMATION TO IRS • Kotter’s 8-step change model

Create urgency

Guiding ‘Coalition’

Develop a Vision

Communicate Vision

• Change driver: Special Needs Strategy: IRS

• Use current evidence to support the need for change locally

• Engage diverse

leaders in the steering group

• Establish a ‘working group’ with stakeholder representation

• Develop strong relationships and partnerships locally

• Program Guidelines articulate a vision

• What do we want to see change to make a positive difference for

children with special needs and families

• Create a strategy to communicate and execute vision

• Frequent, clear,

concise, honest, 2-way communication

• Tackle anxieties openly

• Empower others by engaging them in

conversation as you begin (preparation phase) and throughout implementation

• Agencies

• Therapists

• Educators

• Community

• Parents

CHANGE/TRANSFORMATION TO IRS

• Kotter’s 8-step change model

Remove Obstacles

Short Term Wins

Build on Gains

Institute Change

• Training up front

• Assess and revise organizational structures and

procedures to fit with the new approach

• Use the Vision!

• Recognize staff and programs for their contributions - provide incentives for implementing a tiered approach

• Share strategies

that work

• Regular ‘Update’

sessions with all stakeholders

• Ongoing mentorship for sustainability

• Program evaluation

after year one – what have we learned so far?

• Set indicators and outcomes based on experience and learning – involve all stakeholders in setting these up

• Continue to develop training and mentorship resources

“TRANSFORMATION TAKES TIME”

• Establish a ‘change management’ plan

• Preparation is needed before implementation • Use Implementation Science framework to identify factors and

strategies

• Get the environment ready

• Bring all stakeholders together

• Start education and training of everyone early

• BUILD RELATIONSHIPS!!!

• A ‘transition’ period of implementation from the ‘old’ approach to the ‘new’ approach is important • Learn from experience and from each other

• Collaborative problem solving

BIBLIOGRAPHY

American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association (2014). Workload approach: A paradigm shift for positive impact on student outcomes. Retrieved July 16, 2016 from www.asha.org/uploadedFiles/ASHA/Practice_Portal/Professional_Issues/Caseload_and_Workload/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-Schools.pdf Barr, J. & Dowding, L. (2016). Leadership in health care. Third Ed. Thousand Oaks, CA: Sage Publications Ltd. Camden, C., Swaine, Tetrault, S., & Carriere, M. (2011). Going beyond the identification of change facilitators to effectively implement a new model of services: Lessons learned from a case example in paediatric rehabilitation. Developmental Neurorehabilitation, 14, 247 – 260.

Camden et al., 2016 (in preparation). A framework for study implementation of an intervention. Kotter International (2016). The 8-step process to leading change. Retrieved July 26,2016 from http://www.kotterinternational.com/the-8-step-process-for-leading-change/ Missiuna, C., Hecimovich, C., Dix, L., Campbell, W., Pollock, N., Bennett, S., Camden, C., Decola, C., McCauley, D Gaines, R., Cairney, J., & Stewart D. (2015). Partnering for Change: Implementation and Evaluation, 2013 – 2015. Final Report for the Ontario Ministry of Health and Long Term Care and the Ontario Ministry of Education. Hamilton, ON: CanChild, McMaster University. Available at www.partneringforchange.ca

RESOURCES

Campbell, W., Selkirk, E., & Gaines, R. (2016). Speech-language pathologists’ role in inclusive education: A survey of clinicians’ perceptions of universal design for learning. Canadian Journal of Speech-Language Pathology and Audiology, 40(2), 121-132.

CAST. (2011). Universal design for learning guidelines version 2.0. Wakefield, MA: Author.

Causton, J., & Tracy-Bronson, C.P. (2014). The speech-language pathologist’s handbook for inclusive school practices. Baltimore, Maryland, USA: Paul H. Brookes Publishing Co.

Causton, J., & Tracy-Bronson, C.P. (2014). The occupational therapist’s handbook for inclusive school practices. Baltimore, Maryland, USA: Paul H. Brookes Publishing Co.

Giangreco, M.F. (2002). Absurdities & realities of special education: The best of ants…,flying…,and logs. Minnetonka, MN, USA: Peytral Publications, Inc.

Hanft, B. & Shepherd, J. (Eds) (2008). Collaborating for student success. A guide for school- based occupational therapy. Bethesda, MD: American Occupational Therapy Association.

Labrie Blackwell, A., & Dunn, W. (2016). Active ingredients for an embedded intervention within the early childhood classroom. Journal of Occupational Therapy, Schools, & Early Intervention, 9(2), 125-141.

Laverdure, P. (2014). Considerations for the development of expert practice in school-based occupational therapy. Journal of Occupational Therapy, Schools, & Early Intervention, 7, 225-234.

Lidz, C.S., & Pena, E.D. (2009). Response to intervention and dynamic assessment: Do we just appear to be speaking the same language? Seminars in Speech and Language, 30(2), 123-133.

Morse, A. (2015, August 10). Glossary of special education terms. Retrieved from http://education.easterseals.org/glossary-of-special-education-terms/

R.A. Malatest & Associates Ltd. (2014). Review of integrated full day kindergarten children’s treatment centre pilots: Definitional report. Ontario Ministry of Children and Youth Services. Toronto, ON, Canada.

Roberts, G. (2015). Communities of practice: Exploring enablers and barriers with school health clinicians. Canadian Journal of Occupational Therapy, 82(5), 294-306

WEB-BASED RESOURCES

CAST is a non-profit education research and development organization that works to expand learning opportunities for all individuals through Universal Design for Learning. http://www.cast.org/

CONNECT Professional Development Modules from the Center to Mobilize Early Childhood Knowledge. http://community.fpg.unc.edu/

Frank Porter Graham Child Development Institute. Generates knowledge, informs policies and supports practices to promote positive developmental and educational outcomes for children from all backgrounds and abilities from the earliest years. http://fpg.unc.edu/

Ontario Centre of Excellence for Child and Youth Mental Health. They have a series of short modules including: leading organizational change and teamwork and collaboration, www.excellenceforchildandyouth.ca/resource-hub/learning-modules

Professional learning resources for Alberta educators developed by Alberta Education http://www.engagingalllearners.ca/

Schoolwide Integrated Framework for Transformation (SWIFT). Swift is a K-8 technical assistance center that builds school capacity to provide academic and behavioural support to improve outcomes for students through equity-based inclusion. http://www.swiftschools.org/

SNOW is the branch of the Inclusive Design Research Centre at OCAD University that focuses on inclusive education and learning. Their goal is to provide information and training for educators, parents and students with disabilities on technologies for learning both in and out of the classroom as well as promote understanding of inclusive practices. Resources are free whenever possible and SNOW focuses on providing open source tools that can be adapted and used freely. http://www.snow.idrc.ocad.ca/

UDL Supporting diversity in BC Schools. The content of the site was developed from a variety of print and online resources and is intended to provide K-12 educators with a starting point for implementing Universal Design for Learning in their classrooms. http://www.udlresource.ca/

Questions?

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Thank you!

For additional information and updates:

specialneedsstrategy.children.gov.on.ca

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