WHAT DOES IT TAKE? 5 Lessons Learned from Supporting Evidence-based Home Visiting to Prevent Child Maltreatment Virginia Home Visiting Consortium Meeting October 29, 2013 Melissa Lim Brodowski Office on Child Abuse and Neglect Children’s Bureau, ACYF, ACF, USDHHS 1

Arriving at meaningful solutions is an inevitably slow and difficult process. Nonetheless..better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try. 2 From Atul Gawande in Better

5 Key Lessons Learned 1.Implementation matters. 2.Know your data. 3.Partnerships are key. 4.Systems trump programs. 5.Embrace complexity. 3

Implementation (quality) matters. 4

Socially Significant Outcomes Effective & Usable Interventions Effective Implementation Methods Enabling Contexts Formula for Success © 2012 Dean Fixsen and Karen Blase, National Implementation Research Network

What is Quality Implementation? –Fidelity –Adaptation –Dosage 6 Imp.cfm

Know your data. 7

Continuous Quality Improvement 8

What? So what does it mean? Now what will we do? Adaptive Action Adaptive Action Process Glenda Eoyang, 2009

For more information, visit:

Fidelity Domain Study Structural (Implementation fidelity) Dynamic (Intervention fidelity) Hiring qualified staff/providing sufficient training and supervision Engaging the target population Achieving recommended dosage and duration Maintaining caseload levels Nature of the provider- participant relationship Manner of service delivery 11

Fidelity Standards Explicit standards Implicit standards Efficiency or best practice standard 12

Caseloads IndicatorMean Standard Deviation Low Score High Score Mean monthly HV caseload (n = 35 IAs) % home visitors at or below recommended caseload (n = 35 IAs) % home visitors below recommended caseload (n = 35 IAs) Source: EBHV Cross-Site Fidelity Database, October 1, 2009 through December 31,

Dosage: IndicatorMean Standard Deviation Low Score High Score # of visits provided/weeks of enrollment for those still enrolled (n = 27 IAs) % of participants who received all of the intended dosage during first 6 months (n = 27 IAs) % of participants who received at least 80% of intended dosage (n = 27 IAs) Source: EBHV Cross-Site Fidelity Database, October 1, 2009 through December 31,

Dropoff Points Screened for service needs Referred to HV programs Enroll in treatment or community services Complete treatment or community- based program Achieve Positive Outcomes Payoff 15 National Center on Substance Abuse and Child Welfare

Partnerships are essential. 16

Four Levels of Collaboration 17 Sid Gardner, 2011

Six Features of a High-Quality Collaborative Process 1.It is inclusive. 2.It treats all stakeholders equally. 3.It is authentic. 4.It focuses on the problem. 5.It has structural integrity. 6.It is revisable. Darrin Hicks, University of Denver

Salem, Oregon 19

Systems trump programs. 20

EXISTING SYSTEM EFFECTIVE INNOVATIONS ARE CHANGED TO FIT THE SYSTEM EXISTING SYSTEM IS CHANGED TO SUPPORT THE EFFECTIVENESS OF THE INNOVATION EFFECTIVE INNOVATION System Change Allison Metz, NIRN, 2013

National Implementation Research Network

EBHV Evaluation Theory of Change 23 Mathematica Policy Research, 2013

Infrastructure Capacities 24 Foundation activities Planning Collaboration Implementation activities Operations Workforce development Sustaining activities Fiscal capacity Community and political support Communications Evaluation

project dulce incorporates interventions into the pediatric primary care setting through the Patient Centered Medical Home Model 25

South Carolina a workforce enhancement intervention and an EB parenting intervention for families with young children with developmental disabilities. 26

Embrace complexity! 27

Why are the best programs working? Theoretical integrity and focused content. Focusing intervention efforts on the earliest stages of the developmental process. Employing persistent, but respectful, outreach methods to engage multi-problem families. Systematically assessing the needs of the target population across a number of domains that impact relevant risk and protective factors. Providing participants access to a core body of knowledge and skills and facilitating access to other community resources as needed. Deb Daro, Pew Summit, Feb

We are in it for the long haul….. 29

and

Contact Information Melissa Lim Brodowski Office on Child Abuse and Neglect Children’s Bureau phone:

33