1. Implementation & Sustainability of a Parenting Program: Building Organisational Capacity Karen Myors A/Prof Virginia Schmied Professor Edward White

2. Outline of Presentation Background to study Triple P Child & Family Health Nurses NSW Parenting Program for Mental Health Strategies for implementation & sustainability Limitations of study

3. Background to study Acknowledgements Qualitative study The Positive Parenting Program (Triple P) Data collected 2002 & 2005 2 metropolitan AHS Focus groups & interviews – 48 nurses Semi-structured interviews – 8 NUMs – 5 background informants Observations of clinical interactions – 20 mothers & their children with nurses Review of documents

4. Triple P The Positive Parenting Program 5 levels This study – Level 2/3 Primary Care – Level 4 Group New addition – Level 2 Selected - Seminar Series

5. C&FH Nurses Model of wellness, primary health care Children - birth – 5 years 2001 survey – 90% of parents/carers had attended a C&FH clinic (NSW Health, 2002) 2005 survey – 45 years average age – C&FHN 3 rd oldest nursing group – > ½ of these nurses worked part time (Australian Institute of Health & Welfare, 2008) Participants in study – > 1/3 C&FHN for 16-35 years

6. NSW Parenting Program for Mental Health 1998 – 2003 Provision of training in parenting programs – Triple P – TIPS Coordinators in each Area Health Service 1,196 workers trained in Triple P 2000 – 2002 Majority of the participants C&FH & Community nurses - 330

7. NSW Parenting Program for Mental Health cont’d Impact of training –  confidence in conducting parenting consultations – Positive impact on service delivery – June 2001 – Dec 2002 >3966 parents accessed Triple P – Ongoing in clinical consultations

8. However …. Despite these positives Barriers to implementation & sustainability existed

9. Effective consultation To me it seems that we chug along on our own & then periodically, some Government Aide or somebody, gets an idea and they’ll just say, ‘what can we do, hah, Early Childhood, we’ll give them a bit of training and we’ll shove them out there’, & really that’s how it’s been going. It’s just hotch potch (FG4:37) I didn’t even know what Triple P was for a long time (FG5:61)

10. Planned implementation At the same time we were rolling out home visiting & started focusing on home visiting & Triple P just got forgotten about (NI1:4) Then Family Partnership training was implemented Triple P – Centre for Mental Health Home Visiting & Family Partnership – Primary Health Care Branch

11. Ongoing support - managers And that budget, let me say, has been the same for the last ten years, it’s never ever changed, ten or even longer. So we’ve always had that same number of full time equivalent nurses in the service and here we are doing more expansive things (MI1:5) There’s always been a very high expectation from my manager … that they (Triple P groups) would be run, and that we would work out a way of doing them (MI6:3)

12. Ongoing support – managers cont’d It was just the practical side of things, when we went to send the people out to do the classes they restricted this. From that point of view I felt personally frustrated. And the other thing they didn’t do was make it clear, to put it in writing, whether we could or couldn’t do things, like pay penalties (MI1:2) The human resources are that we’re not going to get any more, so something gives … there is a big commitment, there’s a lot of preparation (MI4:7)

13. Ongoing support - clinicians … Why can’t we be given the time to run the groups? It’s very frustrating for me (FG1:45). I’d probably run more groups if they were better planned (NI4:3) I felt obligated to ensure that I take my time in lieu when it’s not busy. And I think that’s a little bit unfair (NI4:3) The nurses continued to use the strategies in their clinic practice. Conflict with colleagues

14. Ongoing support – clinicians cont’d Nurses felt devalued So much is expected of us that we’re scrambling all the time to keep up with everything (FG4:32) Most of our practice is that the client & the clinic comes first & we do the rest in our own time … it’s very hard to get time off, very hard to get courses paid for (FG1:36)

15. Ongoing support – clinicians cont’d Documentation Policy & procedure manuals Clinical competency manual Operational manual Minutes of meetings

16. Ongoing support – clinicians cont’d Reflective practice Case conferences – 2002 – nil – 2005 – nil Clinical supervision – 2002 - nil – 2005 - 1 AHS = 3 Sectors Mentors & role models were also important

17. Appropriately skilled workforce Training Accreditation

18. Available resources (We) were treated pretty shabbily… We were really disgusted that we couldn’t get the videos (NI1:4)... We only have one (video) for our whole Area to use.. The follow up was really pathetic … we were given all this wonderful information, we were supported… We were enthusiastic… (NI2:4) but no resources Mine (Triple P resources) are sitting in the cupboard behind you there (MI6:2) Accreditation

19. Lead professional I think for a lot of things in Health, that’s what we do, we set ourselves up and do all these things that are whiz bang and wonderful and you need someone there to lead it on and keep the focus (MI3:6) NSW Parenting Program for Mental Health ceased in 2002 Coordinators still employed in some AHS

20. Lead professional cont’d Clinical Leaders Clinical nurse educators – 2002 – 0 – 2005 – 0 Clinical nurse consultants – 2002 – 0 – 2005 – 1 Nurse practitioners – 2002 – 0 – 2005 - 0

21. End result 1 st AHS – wide implementation while coordinator employed – Not sustained without a coordinator 2 nd AHS – full implementation never achieved – Coordinator employed after initial training – CNC heavily involved in other programs

22. Lessons learnt Effective consultation Planned implementation Ongoing support – managers Ongoing support – clinicians – Time – Recognition – Documentation – Reflective practice Appropriately skilled workforce Available resources Lead professional

23. Limitations of study Small sample Only 2 metropolitan AHS The results may not be able to be generalised