Policies and Procedures: Issues for Implementation, Policy and Scaling

up

Barbara J. Smith, U. of Colorado at Denver and Health Sciences Center

Policy Maker’s Summit

November 17, 2006

Washington, DC

www.challengingbehavior.org

Research Framework: Direct Services/Indirect Supports

Longitudinal, multi-site study (KIDS)

Research on direct interventions/services: e.g., emotional/social competence, parent-child interaction, PBS and cultural diversity, family-centered interventions, interventions with toddlers, program-wide PBS

Research on indirect supports Personnel Preparation and Utilization Administrative Operations and Policy

Promotion, Prevention, Intervention Conceptual Framework: The Teaching

Pyramid

Preventive PracticesPreventive Practices

Building Positive RelationshipsBuilding Positive Relationships

Social and Emotional Social and Emotional Learning StrategiesLearning Strategies

Individualized Individualized Intensive Intensive

InterventionsInterventions

Policy Research: Literature Syntheses, Focus Groups & Surveys

What are the barriers and/or challenges to effective promotion, prevention and intervention services for young children at risk for or who have challenging behavior?

What are policy and administrative strategies/remedies for addressing the challenges or barriers?

Information Sources

Center for Evidence-based Practice: Young Children with Challenging Behavior Literature syntheses re: systems and

policies Focus groups National survey

National TA Center for Children’s MH Discussion groups, Nat’l. scan and TA

with states

Centers’ collaborative survey of states

State Agency Leaders: IDEA Part C, ICC and 619; Child Mental Health; Child Welfare; Maternal and Child Health; Health

Local Program Administrators: Head Start, Child Care (including military programs), Public Schools, mental health consultants, home visitors and other TA providers

Family Members: Lists from PACER and FFCMH, parents involved with programs

National Survey

Focus Groups

619 and Part C Coordinators

Parents (Il., Fl., Co.)

Direct Service Providers (Il., Fl., Co.)

Administrators (Il., Fl., Co.)

Findings

Categories of barriers/challenges

Knowledge & Skills (including

eligibility)

Finance (including eligibility)

Beliefs and Attitudes

Collaboration/Coordination/System

Survey and Focus Groups: Challenges

Beliefs & Attitudes

21%

Knowledge & Skills34%

Finance33%

Collaboration & Coordination

12%

National Survey Focus Groups

Beliefs & Attitudes

24%

Knowledge & Skills33%

Finance31%

Collaboration & Coordination

12%

National Survey: Challenges (Eligibility)

Collaboration & Coordination

12%Beliefs & Attitudes

24%

Knowledge & Skills33%

Finance31%

Knowledge & Skills-240 (Eligibility-17)

Finance-236 (Eligibility-57)

Beliefs & Attitudes-179

Collaboration-90

Eligibility - 24% of Finance

Eligibility - 7%of Knowledge & Skills

Focus Groups: Challenges (Eligibility)

Finance33%

Knowledge & Skills34%

Attitudes & Beliefs21%

Knowledge/Skills-103 (Eligibility-6)

Finance-100 (Eligibility-26)

Attitudes/Beliefs-65

Collaboration/Coordination-35

Eligibility - 26% of Finance

Eligibility - 6%of Knowledge/Skills

Collaboration & Coordination12%

Challenge: Knowledge and Skills (workforce development

& support)

Availability & quality of pre-service training

Availability & quality of in-service training, TA, mentoring and other on-going support

Quality of content of training/support: Evidence-based Eligibility Working with families

High turnover rates

Challenge: Attitudes & Beliefs

Differing philosophies & approaches

Perceptions of children, mental health, social-emotional development and behavior

Perceptions between professionals and parents

Challenge: Collaboration & Coordination

Lack of coordination of programs, systems

and resources/funding streams

Lack of collaboration among service providers

Poor collaboration between professionals and parents

Lack of integrated practice/services

Failure to reach under-served populations

Lack of leadership/ownership

Challenge: Finance

Eligibility criteria and requirements (inconsistent across funding sources, do not support

promotion & prevention, do not include child and family, etc.)

Insufficient resources

Limits on blending resources

Insurance, Medicaid and other third party payment restrictions

Low compensation for EC personnel

Survey & Focus Groups : Strategies/Remedies

Beliefs & Attitudes

31%

Collaboration & Coordination

20%

Finance15%

Knowledge & Skills34%

Attitudes & Beliefs21%

Finance22%

Collaboration & Coordination

16%

Knowledge & Skills

41%

Focus GroupsNational Survey

Remedies: Knowledge & Skills

Availability of pre-service training in evidence-based practices re: young children’s social-emotional development and behavior

Availability of in-service training, TA, mentoring, and other on-going support in evidence-based practices

Availability of information and models of evidence-based practices, programs and systems

Higher compensation and other workforce supports

Awareness campaigns

Remedies: Attitudes & Beliefs

Shared training on evidence-based practices among different professions, agencies and with parents

Awareness campaigns about the importance of young children’s social-emotional development, mental health and behavior

Remedies: Finance

Policies that support blending and coordinating resources

Policies that support promotion & prevention and support reaching children early

Adequate resources for programs and training/TA/on-going, on-site support

Adequate compensation for EC personnel

Remedies: Collaboration & Coordination

Policies that promote collaboration and coordination, e.g., System of care Wrap around Addressing differing eligibility limits

Skills in collaborating with families and other professionals

Addressing attitudes and beliefs (turf guarding, trust, differing philosophies)

Inclusion of diverse stakeholders

Conclusions and Next Steps

There are real policy barriers such as eligibility criteria and service limitations associated with funding sources that are incompatible with a promotion, prevention, intervention model.

By far and away, the majority of barriers to delivering effective promotion, prevention, intervention services to children and families is the lack of know-how and support to implement evidence-based practices.

Strategies that promote, scale-up and sustain the everyday use of evidence-based practices, services and programs in the context of a system.

Creating Supportive EnvironmentsCreating Supportive Environments

Positive Relationships with Children, Families, Positive Relationships with Children, Families, and Colleaguesand Colleagues

Social Emotional Social Emotional Teaching StrategiesTeaching Strategies

Individualized Individualized InterventionsInterventions

Program Wide Adoption

Teacher Training/Implementation

Administrative Supports

Program Philosophy Well defined procedures

Data Based Decision Making Partnerships

with Families

Program Wide Adoption

VALUES

Family Voice

Child and Family Centered

Relationship Based

Culturally Competent

Infused into Natural Settings and Services

Grounded in Developmental Knowledge

Prepared Workforce

Family

ConsortiumMaximized and

Flexible Funding

Building Blocks

Promotion Prevention Intervention

Supports for Parents and Families

Supports for Other Caregivers

Services for Children and Families

Services and Supports

Outcome

Evaluation

Strategic Planning, Interagency Partnerships

Developed by Roxane Kaufmann, GUCCHD

Early Childhood System of CareFosters the social and emotional well-being of infants, toddlers, preschool-aged children and their

families

Policies and Procedures

Infants, Young Children and Families