1. Quality Improvement Team Webinar Childrens Technical Assistance Center (CTAC) Website: ctacny.com

2. Welcome to clinics joining the LC The 4Rs and 2Ss model: What is it? Why is it important? The ABCs of a Learning Collaborative Proposed schedule of LC Activities (October 2011- June 2012) Q&A

3. You are one of over 60 clinics statewide who have expressed an interest in joining the 4Rs and 2Ss Learning Collaborative The clinics who join are the early adopters- those who are committed to improving their services. We very much appreciate your commitment- as an early adopters you are the innovators who contribute to the field and help to improve the entire system

4. This curriculum-based practice is designed to strengthen families, decrease child behavioral problems, and increase engagement in care. The program focuses on parts of family life that have been empirically linked to youth conduct difficulties. The program is available in English or Spanish. The 4Rs and 2Ss is a research informed treatment approach designed to improve parent- child interactions resulting in positive improvements in the childs social behavior and the caregivers parenting behaviors.

5. Does your clinic offer group treatment? If yes, what type of group program ?

6. R ules R esponsibilities R espectful Communication R elationships S tress S ocial Support

7. Reduces stigma associated with raising a child with mental health issues by normalizing each familys experience Emphasis on building family relationships and functioning Each session provides time for families to practice togetherness and communication Emphasis on Roadwork, which promote continued learning outside the group 7 What is the 4Rs and 2Ss for Strengthening Families Program?

8. Group format Meets at least once a week for 16 weeks Optimally closed group after session 3 Group size = 6-8 families Ideally, co-led with parent advocate Groups typically run for 60 minutes Manuals used by families and facilitators 8 What is the 4Rs and 2Ss for Strengthening Families Program?

9. The literature tells us that families that participate in the program are likely to experience the following outcomes: Increased family cohesion Increased within family support Increased family communication Decreased oppositional defiant behaviors Decreased child inattention Decreased parenting stress Decreased problematic parent-child interactions Families stay longer in treatment

10. Network of clinics committed to implementing and sustaining an evidence based practice designed to strengthen family relationships and promote positive social behavior in children with conduct difficulties The learning collaborative brings together 10-15 child serving clinics who share with and learn from each other through collective problem solving and social networking.

11. Have any of you previously participated in a Learning Collaborative?

12. Each participating clinic will….. Successfully plan, implement and complete the 4Rs and 2Ss 16 week multiple family group treatment program. Explore strategies to sustain the 4Rs and 2Ss program (assuming positive outcomes) after the LC ends in June 2012. Be offered an optional opportunity to experiment with applying the 4Rs and 2Ss approach to an 8 week program and/or individual treatment modalities.

13. Your LC is organized and guided by a panel of experts who provide the needed clinical, technical and social supports to achieve the aims of the LC. Your expert panel are faculty of CTAC. For more information about your expert panel see the CTAC website at CTACNY.COM

14. The expert panel provides guidance on how to successfully implement a new practice by: Organizing and facilitating all activities associated with the LC Establishing practical and effective communication channels between and among the members of the LC and the expert panel members Providing high quality training and ongoing support for the staff implementing and providing the new practice Supporting supervisors to promote the development of the staff implementing the program

15. One of the key approaches employed by the expert panel involves assisting each clinic to apply easy to use performance improvement methods : Plan-Do-Check-Act improvement cycles Identification of measureable performance indicators Focus on practical strategies that make sense in the day to day realities of a clinic

16. What do the participating clinics bring to the table?

17. Each organization identifies and empowers a Quality Improvement Team (QIT) who participate in all the LC activities and take responsibility for planning, implementing and evaluating the aims of the LC. The QIT is the interface between their organization and the LC.

18. QIT membership typically includes: an executive-level administrator clinical supervisor of the program that is the focus of the improvement effort person responsible for collecting and submitting data related to performance indicators. Others may also join the QIT based on the aims of the LC (e.g., cultural diversity expert, peer specialist, partnering organization representative) In the 4Rs and 2Ss project, the inclusion of a family advocate/parent partner would be very helpful

19. Does your clinic have a relationship with a family advocate, family partner or family support organization?

20. The identification of key performance indicators that are measurable and allow LC members to assess progress and address challenges is an integral component of a LC. The identification of performance indicators promotes and strengthens the experience of a community among participants by establishing a number of common goals and measures.

21. The performed indicators employed in the 4Rs and 2Ss LC include: Weekly Attendance (the number of families that were enrolled in the 4Rs and 2Ss program and the number that attended) Discontinuation and reasons why (# of families that discontinued during a month and the factors contributing to discontinuation)

22. Family Feedback (completed by participating family members at the beginning, middle and end of the program) Built into the 4Rs and 2Ss manual Focuses on child behavior and aspects of family life Facilitator feedback (at end of program the group facilitator(s) provide feedback on their experience of the program)

23. Fidelity A way of helping facilitators to apply their skills in the program. Supervisors will be involved in assessing fidelity by directly observing a group and completing a fidelity assessment instrument. The fidelity feedback is not part of the practitioners performance evaluation. Rather, the focus is on educational supervision. Opportunity to conduct fidelity via an independent rating

24. The 4Rs and 2Ss LC is likely to include the following activities: 3 face to face meetings of the QITs over the 9 month duration of the LC Typically, one monthly contact with the QITs via one of the following modalities: Individual call Group conference call Special interest calls ( based on the expressed needs of the LC members as the project progresses)

25. One day staff training in facilitating a 4Rs and 2Ss multiple family group Minimum of 2 practitioners (clinical staff, interns) along with a family advocate/partner Consider sending additional staff who may be interested in learning the program and may support your efforts to sustain and/or expand the program. Training is a practical hands on learning experience with a manual used by the group facilitators and the families Training will begin in November 2011

26. What percentage of your services for children involves one or more family members on an ongoing basis? Best estimate. Less than 25 % 26-50 % More than 50%

27. Keep in mind….. CTAC will make adjustments based on the needs and preferences of the LC participating clinics CTAC is always available to consult with clinics to address clinic specific/unique concerns and challenges

28. Oct 2011 Welcoming and Introductory Webinar Orient QIT members to the LC: Expectations and Resources provided Nov Face to face meeting Training of staff begins Building relationships and social networking Clarifying expectations and LC activities Review performance indicators in detail Identifying initial challenges Describe the new practice to be implemented, training plan and next steps Developing a communicating for buy in work plan Dec Individual call to each LC member organization Training of staff ends Follow up on progress, challenges and needs associated with the work plan developed at the face to face meeting. Explore and address challenges associated with implementation, evaluation and organizational buy in. January 2012 Group call Round robin report on progress challenges and needs. Facilitator makes note of challenges and engages members to share solutions and contribute to problem solving focuses on the most common challenges Feb 2 nd Face to face QIT meeting Identify and reinforce progress and address the key challenges encountered by participants as they implement a new practice, policy, procedure or process. Facilitate collective problem solving by eliciting potential solutions from the LC members as well as the recommendations of the expert panel. Each QIT develops a work plan to address one of the challenges/barriers that interferes with meeting the aims of the LC. MONTH ACTIVITYFOCUS

29. March Special interest call Invite staff involved in implementing the new practice or carrying out a new procedure to participate in a group call with their counterparts. Focus on the needs of the key implementers and collectively problem solve on common challenges. AprilIndividual call Follow up on progress, challenges and needs associated with the work plan developed at the face to face meeting. Explore and address challenges associated with implementation and evaluation. May General group call Round robin report on progress, challenges and needs. Facilitator makes note of challenges and engages members to share solutions and contribute to problem solving focused on the most common challenges June 3 rd and final Face to face meeting Formal presentations by each LC member. LC members are provided a framework/outline to structure their presentation that includes 1) performance indicators data and 2) steps to sustain the improvement efforts. MONTH ACTIVITYFOCUS

30. Q&A For more information or clarification on the 4Rs and 2Ss learning collaborative, please feel free to contact your LC facilitator and/or your regions logistics coordinator listed below. Facilitators Mary McKay (NYC and Lower Hudson- group A) mary.mckay@nyu.edumary.mckay@nyu.edu Andrew Cleek (NYC and Lower Hudson- group B&C) acleek@uibh.org acleek@uibh.org Anthony Salerno (Long Island) anthony.salerno@nyu.eduanthony.salerno@nyu.edu (New York University partner representative) Thomas Jewell (Central/Western and Upper Hudson River) tjewell@ccsi.orgtjewell@ccsi.org Logistics Coordinator Ashley Fuss (NYC, Long Island): afuss@uibh.orgafuss@uibh.org Dianne Bailey (Western/Central and Upper Hudson) dbailey@ccsi.orgdbailey@ccsi.org