PACE FINAL REPORT Child and Family Centre: Implementation of Solution Focused Brief Therapy

Transcription

1 PACE FINAL REPORT Child and Family Centre: Implementation of Solution Focused Brief Therapy Melissa Anderson, Clinical Manager Submitted February 9, 06 to The Ontario Centre of Excellence

2 Table of Contents Table of Contents... Executive Summary... Introduction... Planning Phase... Doing Phase... 8 Sustaining Phase... 0 Results... Table. Number of clients scoring in the clinical vs. non-clinical ranges on the SDQ.... Figure. Average score on each item of the Single Session Impressions and Feedback Tool.... Conclusion & Next Steps... Appendices... 7 Appendix : Evaluation Framework... 7 Appendix : Logic Model... 0 Appendix : Measures... Referral Form... SFBT Clinician Questionnaire... SFBT Tracking Sheet... 6 Single Session Impression and Feedback Tool (SSIFT) Adapted Version... 7 Strengths and Difficulties Questionnaire (Parent or Teacher -0)... 9 Strengths and Difficulties Questionnaire (Parent or Teacher -7)... 0 Strengths and Difficulties Questionnaire (Self -7)... Appendix : Sustainability & Knowledge Exchange Plan... Appendix : Communication Plan... 8 Appendix 6: Walk In Service Report... 0 Appendix 7: Walk In Infographic...

3 Executive Summary Child and Family Centre: Solution Focused Brief Therapy Melissa Anderson, Clinical Manager In striving for excellence in mental health, CFC recognized the need for implementation of Brief Services as part of its core service delivery model to fall in alignment with the new Ministry Draft Core Services Framework for timely access to programs and services. The PACE project has provided us with the opportunity and guidance in implementing evidence-informed practices (EIP), specifically, SFBT as well as the process for sustaining EIPs in the long term through exploration of fidelity of practice/implementation approaches. A core team has been sustained and the Walk-In Service was established and expanded along with the creation of a core team of continuous improvement professionals across the Agency. The Purpose To implement Solution Focused Brief Therapy as part of the core service delivery model at the Child and Family Centre. To implement an evidence-informed brief service for children, youth and families. To embed in the CFC culture program evaluation activities To support the culture of program evaluation activities through the creation of a department of continuous improvement professionals to guide future implementation of EIP s at CFC. The Program The selected EIP is Solution Focused Brief Therapy. The Child and Family Centre (CFC) is a children s mental health agency accredited with Children s Mental Health Ontario. The Agency provides a broad range of clinical services to children, youth and their families up to the age of 8. Services are offered in schools, homes, and community settings in both urban and rural regions in the Districts of Sudbury and Manitoulin. SFBT has been implemented in the creation of the Walk-In Service in both urban and rural settings providing direct and immediate access to quality, evidence-informed treatment practices to children, youth and families. This new practice is in alignment to the Ministry Draft Core Service Framework for Brief Services. The Plan In Year Two, the Agency established a Single Session Walk-In Service to implement SFBT in alignment with the new Ministry core service framework. The Walk In pilot initiated in July 0 and ended in December 0 with the primary results informing the future service. As a result of the pilot, the evaluation framework, outcome measures and logic model were all revised. The Training Plan was completed in 0 having staff trained in specific modules for Anxiety, Depression, Self-Harm and Addictions to enhance the clinical skills of the staff working in the Walk-In Service. In 0-6, the Walk-In Service was also expanded to the rural area of Espanola. Walk-In Services are currently being provided to high school students one day per week in the high school setting. Further expansion of Brief Services into the community and also to other rural communities is underway following the completion of engagement activities with youth and families in these communities in 06. Expansion of Urban Brief Services is also underway in partnership with Health Sciences North (HSN), the local hospital who delivers Crisis Services. The launch of a Brief Services Model including a co-location with HSN is expected in early May 06. The concept under development is that clients presenting to Crisis who are not at immediate risk of harm to self or others will be diverted to the Brief and/or Walk-In Service using an SFBT approach.

4 The Product SFBT has been successfully implemented in the Walk-In Service in both urban and rural areas with expansion underway in both settings. Utilizing youth, family and community engagement along with continuous program evaluation activities, expansion of services is informed with measurable data, critical success factors and input from stakeholders. Knowledge gained throughout the course of the PACE project has allowed CFC to embed within its culture a department of professionals vital to assisting the successful implementation and sustaining of EIP s across services and to evaluate the effectiveness and outcomes in CFC core services. Examples of other EIP s successfully implemented at CFC include Cognitive Behavioural Therapy, Triple P, Trauma Treatment (Crisci Model), FRIENDS Anxiety Groups and Motivational Interviewing. In consultation with community stakeholders, the CFC utilizes strategic planning processes to determine a comprehensive training plan for staff on an annual basis to meet the emerging needs of clients in our communities. Data gathering activities, community consultations and analysis of CFC s client profile on an ongoing basis allows the Centre to determine the types of EIP training needed to ensure cutting edge EIP s are selected and successfully implemented and evaluated. Most recently, CFC has been selected as Affiliate Site for SNAP (Stop Now and Plan) for Middle Years (6- years) at risk youth. Knowledge Exchange opportunities are also embedded in CFC s culture and occur both internally and externally with staff and community and provincial partners. Amount awarded: $00, Final report submitted: February 9, 06 Region: MCYS region

5 INTRODUCTION The Child and Family Centre (CFC) is an accredited children s mental health agency which provides services to children, youth and families in the districts of Sudbury and Manitoulin. CFC offers a broad range of mental health services at the Centre, in community, in home and in school settings. These services include brief services through our Walk-In Service, Crisis services in partnership with the local hospital, counseling and therapy services, intensive services, specialized services such as trauma and eating disorder treatment along with a full range of diagnostic and treatment services through both Clinical and Psychology services, in addition to intensive support and supervision services for youth in conflict with the law. The CFC was successful in achieving a People Advancing Change through Evidence (PACE) grant in 0 to implement and evaluate Solution Focused Brief Therapy across services at the Centre with the goal of sustaining the evidence based practice beyond the life of the three-year grant. The demand for time-limited or short term therapy services was necessary to increase access to high quality treatment and relieve increasing wait list pressures. The Centre also strategically aligned itself to the Open Minds, Healthy Minds (0), Ontario s comprehensive mental health and addictions strategy to address the needs of the communities in which children, youth and families are served. Further CFC was committed to delivering high quality mental health services through the implementation and sustainability of evidence-based practices in all of its services through strategic planning. The Centre was cognizant from the beginning of the project that effective planning, strategic implementation, and practice fidelity were necessary for effective sustainability of any evidence based practice. Since being awarded the PACE grant, the CFC re-defined its brief services in accordance with the new Ministry framework and aligned its services through the launch of a Walk-In Service in the Greater City of Sudbury and recent expansion to one of its rural areas to meet the new core service guidelines.

6 The PACE project focused solely on the Walk-In Service as a mechanism to inform the future of implementing and sustaining evidence based practices at the Centre. The overall goals of implementing Solution Focused Brief Therapy by means of the Walk-In Service was to increase quick access to high quality services to children, youth and families in the City of Greater Sudbury and recently in rural as our wait list pressures increased. The Walk-In was viewed as a viable alternative to Crisis services where children, youth and families could access clinical expertise for a single session focusing on a strengths-based and collaborative model of treatment between clinician and client. Further, it was posited that the Walk-In Service would relieve some of the wait list pressures and improve the lives of children, youth and families in our community. PLANNING PHASE The first year of the PACE grant focused solely on planning for the implementation of Solution Focused Brief Therapy across the Centre s services. The core team was identified consisting of front line clinical staff, an IT and data analyst staff member, a Psychologist identified as the Research Lead, a Clinical Manager as the Project Lead who was supported by the Director of Clinical Services as a co-lead to the project. The staff invited to participate spanned numerous services at CFC to ensure representation with the long term goal of sustainability as we moved into the future. Multiple activities occurred throughout the year including ongoing training with Centre of Excellence, consultations with the PACE Knowledge Exchange Broker assigned to the Centre as well as active communication with staff, regular updates and contests about the PACE initiative. Stakeholder Engagement was completed through presentations to community partners as well as through operational review meetings with stakeholders. The Centre undertook a Youth Engagement initiative in the spring of 0 and was successful in the implementation of a Youth Engagement group to support the Youth Engagement initiative with the Centre of Excellence. Through 0, one of the

7 primary goals at CFC was to sustain the Youth Engagement initiative and keep community partners informed as well as having initiated family/parent/caregiver engagement activities. In regard to Organizational Capacity, the Agency explored the workload demands of PACE to support the process of successful implementation of evidence based practices across the Centre s services. The goal of implementation of SFBT was to assist in providing differential levels of services, meaning staff will be able to provide less intensive services for lower risk clients and more intensive services for higher risk clients. Consequently there were goals to reduce wait list pressures and overall wait times for clients and families which would subsequently improve clinician caseload demands. In consultation with other provincial Agencies awarded the PACE grant, CFC identified tools and measures for outcomes. These questionnaires were modified with permission to reflect Clinician Knowledge and Use of Solution Focused Brief Therapy and Confidence Using Solution Focused Brief Therapy. We also explored the use of the PROQOL: Professional Quality of Life Scale and a Team Functioning Scale. Through the development of the Program Evaluation framework new outcome measures were explored including the CDOI (Client-Directed Outcome-Informed Therapy by Miller and Duncan). The CDOI has two rating scales, the first being the ORS (Outcome Rating Scale) and the second being the SRS (Session Rating Scale). The ORS was identified to measure client progress since the last session was administered prior to session and the SRS administered at the conclusion of the session identified to measure the client s overall therapy experience. The PACE team recognized that the use of the current CFC measure (CAFAS) would not fully meet the needs of the PACE initiative. A clinical Supervision Tool was also developed as an internal audit mechanism of clinical files. The results of 0 indicated that SFBT could be a mechanism to assist with assessment and treatment planning. As a result of system transformation in the children s mental health sector across Ontario, CFC undertook to enhance its service delivery model to include the incorporation of brief services. SFBT 6

8 was one form of therapy to be utilized as part of the continuum of services from lower to higher intensity based on the client s presenting problem. Throughout the planning process, different need s assessments were completed. Upon initiation of the project, a Checklist to Assess Organizational Readiness (CARI) was completed by core team members and can be found in Appendix. The purpose of the CARI was to identify areas of strengths, needs and priorities for CFC in preparation for the initiative. The results of the CARI indicated that system capacity required the core team s attention to focus on stakeholder engagement activities, informing CFC funders about the importance of implementing and sustaining evidence based practices and the potential for expenditures related to such projects as well as setting up mechanisms for sustaining the implementation of evidence based practices. The staff needs assessment revealed that clinical staff were amenable to brief services and 0 % of staff reported some limited training in brief service models. Consultation with trainers allowed the PACE team to establish a comprehensive training plan in Solution Focused Brief Therapy based on the needs of clients in the Districts of Sudbury and Manitoulin. The second objective during the Planning Phase was to determine the best fit between program/service and SFBT. The core team in consultation with Leadership and Senior Leadership identified services best suited to the implementation of SFBT including crisis, brief services as well as counselling and therapy. A comprehensive literature review was undertaken to ensure best fit for service and was ongoing throughout the life of the PACE grant. The final objective of the Planning Phase was to develop an Implementation Plan for Training, Supervision, Program Evaluation and Knowledge Exchange of SFBT. A training plan framework was established based on the needs of client s in the Districts of Sudbury and Manitoulin. Through consultation with trainers, a training plan that provided staff and leadership with a Certificate in Solution 7

9 Focused Brief Therapy was created. The training plan framework considered training for the Leadership team, front line staff and administrative support staff along with further enhancement of a supervision model and fidelity of practice and implementation framework through consultation with experts in the field, peer mentorship and Train the Trainer modules. The Training modules considered included: ) An introduction and overview of SFBT; ) SFBT with children adolescents and families; ) SFBT for depression; ) SFBT for anxiety disorders; ) SFBT for suicide and self-harm; 6) SFBT for treatment of addictions. Additionally the Leadership team was to receive specific trainings in supervision of SFBT and Train the Trainer Modules for identified champions in SFBT to sustain internal capacity. Over the course of the planning process, deliverables completed included the 0 implementation plan which identified the tasks, activities, tools and results for the successful implementation of SFBT at the Child and Family Centre. DOING PHASE The Child and Family Centre underwent a great deal of change at the end of the Planning Phase and transition to the Doing Phase of the PACE initiative. As 0 drew to a close and CFC embarked on 0, the Centre experienced an internal transformation of both Leadership and Senior Leadership. Our Executive Director retired, our Director of Clinical Services transitioned to the Executive Director position and a new Director of Clinical Services was hired. Simultaneously, CFC was named Lead Agency for its Service Area and was required to align all services to the new Ministry of Children and Youth Services (MCYS) Draft Core Service Delivery Framework. As the year progressed increasing pressures and changes were further experienced including the departure of three of five Clinical Managers coupled with a high turnover in front line staff. Consequently, there was significant change to the PACE team constellation and approach to implementation. The training process was slow to start with first 8

10 module being delivered in the spring of 0 however the implementation of SFBT was initiated as the identified EIP in July 0 with a new Walk-In Service. As CFC journeyed through significant competing pressures and changes, it was clear the initial proposed scope of the PACE project was much too broad and comprehensive. Through support and consultation with the Centre of Excellence, it was determined that the most appropriate course of action would be to focus our project solely on the initiation of the Walk In Service resulting in a multitude of changes from beginning to end of the project. In July 0, CFC launched the pilot of a child and youth mental health Walk-In Service. The Walk-In Service pilot offered single sessions to children, youth and families in the Greater City of Sudbury utilizing Solution Focused Brief Therapy. The service was offered one day/evening per week with both English and French clinical staff available to support walk-ins. The CDOI was administered to each client at the initiation and conclusion of each session. The pilot reached its conclusion in December 0 and yielded mixed results. The most significant barrier to the project was the lack of uptake in the community. These results informed the decision to re-locate the service to our more central downtown office and increased advertising and marketing as well as an exploration of the tools and measures employed. In January 0, the Walk-In Service was adopted as a full service and the response rate has greatly improved. The Walk-In Service measures were changed to the Strengths and Difficulties Questionnaire (SDQ) at the initiation of service while the Single Session Impression and Feedback Tool (SSIFT) was utilized at the conclusion of session. In regard to the PACE Project, the high turnover in staff at all levels resulted in only a few remaining members to the core team. At the same time, new staff dedicated to the Walk-In Service assisted the remaining members with the implementation of service and recommendations contributing greatly to the project. In November 0, CFC and remaining PACE 9

11 core team members were able to work closely with a consultant and the Centre of Excellence to reestablish a new evaluation framework to reflect the new project scope. Data gathering continued through 0 on the Walk-In Service. SUSTAINING PHASE Year three of the PACE Project focused on sustaining activities and ongoing data gathering mechanisms to inform our Walk-In Service and potential expansion of the Walk-In both in urban and rural locations. The sustainability plan was drafted to address core areas to ensure successful implementation and inform future decision making. Core areas addressed through the sustainability plan included leadership, capacity building, service development, knowledge exchange activities, communication and staff engagement, monitoring and evaluation as well as financial resources. The leadership team underwent training in Implementation Science in early 0. Simultaneously, the Centre hired a Director of System Management and Quality to oversee all continuous improvement activities including program evaluation, research and service development at CFC. Through the support of the Director of System Management and Quality, CFC undertook the revision of all policies and procedures to ensure alignment to the new Ministry Draft Core Service Delivery Framework and for the purposes of meeting new Accreditation standards. Throughout this process, capacity building occurred and continues across all levels of the organization. Staff and community engagement activities were ongoing as CFC provides mental health treatment services solely utilizing evidence based practices. Consultations with family, youth and community partners are critical to determine the needs of the community and consumers of mental health services to ensure CFC provides the best possible care for improved long term positive outcomes. CFC has been successful in the implementation of SFBT in the Walk-In Service in both urban and rural locations and is exploring 0

12 additional mechanisms to deliver the service in the community as well as across other services within CFC s Core Service Delivery Framework. Through community partnerships and formal professional development activities, CFC continues to train new staff in SFBT through in-services and mentorship with identified SFBT Centre champions as well as providing professional development opportunities as they arise for new staff. The continuous improvement activities at CFC allow for ongoing monitoring and evaluation of all services and specifically to the PACE project for the Walk-In Service. The use of specific tools designed to measure outcomes and client satisfaction have provided CFC with specific information regarding the implementation of SFBT in the Walk-In Service. CFC utilized the Single Session Impressions and Feedback Tool (SSIFT) along with the Strengths and Difficulties Questionnaire (SDQ) to assist with measuring outcomes related to the Walk-In Service. A dashboard was created to support the data analysis of all measures and as a mechanism to monitor the ongoing Walk-In activities. The results are as follows. RESULTS Descriptive analyses were performed on the Walk-In Service pilot data (collected between July 6, 0 and February 9, 06), which includes: client demographics, the Strengths and Difficulties Questionnaire (SDQ) Parent and Child versions, and the Single-Session Impressions and Feedback Tool (SSIFT). The Strengths and Difficulties Questionnaire is used to identify behavioural and emotional problems in children and adolescents (Goodman, 00). The items in the SDQ comprise scales of items each, these scales include: conduct problems, hyperactivity, emotional problems, peer problems, and prosocial behaviour. Parent and teacher versions of the SDQ are available for those aged to 6 and a youth self-report version is available for youth aged to 6. The Single-Session Impressions and Feedback Tool is a short, 0 item tool utilized to elicit process/outcome information following a brief

13 narrative walk-in clinic conversation (Cooper, 0). Eight of the questions are scored on a -item Likert scale and two questions are open-ended to allow for a narrative response. This tool has been endorsed by Children s Mental Health Ontario. Since the launch of the Walk-In Service in July 0, Child and Family Centre clinicians have provided sessions of Solution Focused Brief Therapy to 07 unique clients. Nearly half (8%) of these sessions were provided in the last six months. On average, female Walk-In clients were.8 (±.) years of age and male clients averaged 9.8 (±.9) years of age. Nearly a quarter (.%) of Walk-In clients were female youth aged -, 8.9% of clients were males 6 to 0 years of age, and 8.0% of clients were females aged -7. The most commonly reported reasons for visiting the Walk-In Service were stress and anxiety (0.%), behaviour/ aggression/ impulsivity issues (.6%), and also concerns with depression and sadness (7.9%). Of the 6 children/youth who completed a SDQ (Self-report), 97% achieved a score placing them in the clinical range for Total Difficulties. In addition, more than out of (77%) individuals reported having clinical difficulties on the Emotion scale and just over half (%) of individuals reported clinical difficulties on the Peer Problem scale (see Table x for more details). In contrast, only of the 7 parents (6%) who completed a SDQ (Parent-report) reported their child as belonging in the clinical range for Total Difficulties. However, the majority of parents did indicate that their child scored within the clinical range for difficulties with Emotion (67%) and/or Peer Problems (%) (see Table x for more details).

14 Table. Number of clients scoring in the clinical vs. non-clinical ranges on the Strengths and Difficulties Questionnaire (SDQ). Self Report Parent Report (n = 6) (n = 7) Clinical Non-clinical Clinical Non-clinical Total Difficulties Score 9 7 Emotion 7 7 Conduct 7 8 Hyperactivity 9 6 Peer problem 8 0 Prosocial behaviour Total Difficulties Score 97% % 6% 6% Emotional Problems 77% % 6% 6% Conduct Problems 8% 6% 6% 6% Hyperactivity % 6% 7% 7% Peer Problems % 7% 6% 6% Prosocial Behaviour % 97% % % *Clinical cut-offs are norm-based for each scale. Following the session all clients were asked to complete the SSIFT. Of the 79 clients who completed the SSIFT, 96% found their conversation with the clinician useful and 90% left the session feeling hopeful (see Figure x for more details). Under Improvements very few clients left feedback however those that did stated that the session was good the way it was, perfect, great, and exactly what I needed.

15 Figure. Average score on each item of the Single Session Impressions and Feedback Tool (SSIFT). Single Session Impressions and Feedback Tool (SSIFT) Client Feedback Scale Focus My therapist focused on what they wanted to and my wishes didn't seem important Interest The conversation was uninteresting to me Your Skills My therapist did not learn about my skills, abilities, or wisdom Partnership I felt out of the work today Feedback My therapist kept going without checking in with me Plans/Next Steps.7.6. My therapist addressed what I/we wanted to talk about the most The conversation captured and held my interest My therapist learned about my skills, abilities and wisdom.7 I experienced being an important partner in our work together today.7 My therapist asked for my feedback throughout the conversation I played no part in developing the plan and next steps.7 I played a large part in developing the plan and next steps Hope I felt hopeless after the conversation.7 I felt hopeful after the conversation Useful The conversation was not useful.76 The conversation was useful Further breakdown of clients served in the Walk-In Service were % male and 8% female. In terms of language and culture, 87% of clients accessing Walk-In were English, % were French and % identified as First Nations. The City of Greater Sudbury encompasses a larger geographic area with numerous smaller communities. Those accessing Walk-In Services identified as coming from surrounding communities within the Greater City of Sudbury.

16 CONCLUSIONS AND NEXT STEPS Over the course of the PACE Project, CFC has learned and successfully employed the strategies to implement and sustain Solution Focused Brief Therapy in its Brief Services through the Walk-In Service. As a learning organization, CFC has also successfully embedded continuous improvement activities into its culture and across all services. The creation of a department of professionals dedicated to evaluation activities supports all services in ensuring informed decision making based on measurable data and evidenced informed techniques. Prior to the PACE project, CFC utilized client satisfaction questionnaires and a handful outcome measures across services to monitor and inform decision making. Data analysis was limited and often inconsistent. Through the PACE Project and other program evaluation activities supported by the Centre of Excellence, CFC has been successful in establishing program evaluation activities into the Centre s culture. Although the PACE project focused solely on the implementation of Solution Focused Brief Therapy, several other evidence based practices have also been successfully implemented, evaluated and sustained. The use of logic models and process mapping are now part of the organizational activities services ensuring clarity and accountability of all those involved. The use of data management systems including our overall client service data management system, dashboards and various project management and evaluation software assist in ensuring the sustainability of data gathering and evaluation systems in all of CFC s work. CFC uses evaluation activities on a daily basis to support not only EIP implementation but also to engage in waitlist management and client case assignment to services. CFC also utilizes literature reviews to inform decision making practices and policy development. The importance of engagement activities for youth, families and community partners has also been recognized and practices adopted and expanded over the past three years at CFC. Lead Staff have been identified and employed to ensure that each year activities are dedicated to gathering the

17 perspectives and stakeholders in the community to assist with strategic and operational planning processes. Activities occur in both urban and rural areas and data is used to inform service planning and training needs of staff to ensure the CFC is undertaking clinical and cultural training activities that meet the needs of the children, youth and families served across the district. In 0-6, the Walk-In Service was also expanded to the rural area of Espanola. Walk-In Services are currently being provided to high school students one day per week in the high school setting. Further expansion of the service into the community and also to other rural communities is underway following the completion of engagement activities with youth and families in these communities in 06. Expansion of the urban service is also underway in partnership with Health Sciences North (HSN), the local hospital who delivers Crisis Services. The launch of the expanded urban Walk-In including a co-location with HSN is set for May, 06. The concept under development is that clients presenting to Crisis who are not at immediate risk of harm to self or others will be diverted to the Walk-In Service for a single session of SFBT. CFC Staff will be available at the co-located site to provide these immediate brief services. The current measures employed for data gathering will continue at the co-located site. Further, CFC has committed to developing a comprehensive Brief Service model in alignment with the Ministry s Draft Core Service Framework. As such exploration is underway to determine a Brief Service Model at CFC that also meets the needs of community stakeholders including the possibility of offering more than one session to clients in the new model. This model may also assist with the Centre s exploration of alternative pathways to service to ensure there is no wrong door to service. 6

18 APPENDIX PACE WALK-IN SERVICE PROCESS EVALUATION FRAMEWORK Evaluation Questions (What do we want to know about this program?) Link to activities or target population in logic model Indicator(s) (What is one possible measurable approximation of the outcome?) Data Collection Method(s) Data Collection Tool(s) (What data collection method will be used to measure the indicator? (What specific tool will be used? Specify the name and whether it is a standardized tool or internally-developed) e.g., Survey, focus group, interview, document review, etc.). Did the staff s knowledge of SFBT increase after Training?. Are Clinicians delivering SFBT as intended? Respondent(s) (Who will provide the information needed? For example, parent, child, clinician, teacher, program staff, etc.) Person(s) Responsible for Data Collection (Who is responsible for ensuring the data are collected?) Timing of Data Collection (When will the data be collected?). Training. Perceived Knowledge of SFBT. SelfAdministered Questionnaire. SFBT Clinician Questionnaire. Staff Training Participants. PACE Team. Questionnaire to be administered Pre and Post. Training. Increased consistency in SFBT practice pre and post training as reported by Clinicians and Managers. SFBT Supervision. SFBT Supervision Checklist. Management. Manager. Clinicians. Manager Pre-training, post-training, and 6-month follow up.. Supervision. Self-Report. File audit. SFBT Clinician Questionnaire. File audit. Consistent use of SFBT tools in sessions as reported in case notes and 7

19 video and audio recordings. What factors limit the effectivene ss of SFBT. Providing SFBT Supervision Number of limiting factors identified. Community of Practice. Continuing Education Opportunities. Do Clinicians feel more competent in their clinical skills with the addition of SFBT training. Training. Supervision. Perceived efficacy using SFBT. SemiStructured Interview (Client/ Client Caregiver). Walk-In Referral Form. Client/ Client Caregiver. SDQ -8. Client/ Client Caregiver. SemiStructured Interview (Staff). Single Session Impressions & Feedback Tool (SSIFT). SemiStructured Interview (Focus Group) or Community of Practice.. Qualitative Data Collection using a semistructured interview questionnaire Manager. Pre Session. Pre Session. Post Session. Client/ Client Caregiver. Staff and Managers. PACE. Ongoing 8

20 PACE WALK-IN SERVICE PROCESS OUTCOME EVALUATION FRAMEWORK Evaluation Questions (What do we want to know about this program?) Link to outcomes in logic model (What outcome from the logic model does the evaluation question relate to?) E.g., Increased selfesteem Indicator(s) (What is one possible measurable approximation of the outcome?) E.g., Increased score on the Rosenberg SelfEsteem Scale Data Collection Method(s) Data Collection Tool(s) (What data collection method will be used to measure the indicator? (What specific tool will be used? Specify the name and whether it is a standardized tool or internally-developed) e.g., Survey, focus group, interview, document review, etc.) Respondent(s) (Who will provide the information needed? For example, parent, child, clinician, teacher, program staff, etc.) Person(s) Responsible for Data Collection (Who is responsible for ensuring the data are collected?) Timing of Data Collection (When will the data be collected?). Has SFBT improved client functioning?. Increase in overall Client/ Client Caregiver functioning. Higher scores on the SSIFT. Self-Report. SSIFT. Client/ Client Caregiver. Clinicians, Managers. Post Session. Clients have access to competent SFBT service deliverers. Fidelity of SFBT delivery is demonstrated by Clinicians in session and during supervison. Fidelity of SFBT delivery. Observational. SFBT Tracking sheet. Staff, Managers. Managers Observational data collected during session; SFBTSC collected during supervision. Supervision. File Audit. SFBT Supervision Checklist (SFBTSC) 9

21 APPENDIX PROGRAM LOGIC MODEL-SOLUTION FOCUSED BRIEF THERAPY-CHILD AND FAMILY CENTRE NEED IN THE COMMUNITY: PROMPT ACCESS TO EFFECTIVE BRIEF MENTAL HEALTH SERVICES; LONG WAITLISTS TO SUCH SERVICES MAY EXACERBATE MENTAL HEALTH CONDITIONS AND PROLONG DISTRESS. PROGRAM GOAL(S): TO IMPLEMENT SFBT ACROSS FOUR PROGRAMS IN ORDER TO IMPROVE PROMPT AND EFFECTIVE MENTAL HEALTH SERVICES TO CHILDREN, YOUTH AND THEIR FAMILIES. RATIONALE(S): BRIEF INTERVENTIONS DELIVERED IN AN ACCESSIBLE MANNER SUCH AS SFBT ARE ONE METHOD OF ADDRESSING PROBLEMS ASSOCIATED WITH WAITLISTS AND LIMITED ACCESS TO CARE. TARGETED SERVICES AND POPULATIONS ACTIVITIES Crisis: Children 0-8 years and their family Counselling and Therapy: Children (0-8 years) and their family Training Participate in 6 modules of training including principles of SFBT, applications, SFBT for anxiety, depression, suicide/selfharm and addictions Brief: Children (0-8 years) and their family Intervention Orientation Review assessment intake or referral Offer -8 session(s) focusing on strengths, resources, goals and solutions Contact client Receive support/consultation and on-going supervision Supervisor module for managers SHORT-TERM OUTCOMES Increase understanding and knowledge of the SFBT approach Train the trainer model MEDIUMTERM OUTCOMES LONG-TERM OUTCOMES Meet with client: Increase utilization of SFBT approach Participate to team meetings and complete administrative tasks ) Orient client to service ) Develop brief treatment plan Develop a closing summary Increase staff and supervisors confidence in using SFBT Maintain practice in developing SFBT skills Decrease suicide, self-harm behaviours and addictions Decrease internalizing problems of clients 0

22 APPENDIX Sudbury Child and Family Centre Walk-In Service Referral Form. Client Information: Client s Date: Name: Client s Client s Cultural Date of Birth: Age: Identity: Client s Primary Language: English French Other Gender: Client s Grade: School: Home Address: Cell# Work# City: Home# Postal Code:

23 . Guardianship: Who is the legal guardian(guardians) for this child/youth.. Parent/Guardian Information: Is this the primary contact person Yes Parent/ No Cell# Guardian Name: Work# Relationship to Client: Address same as above? Yes No Home# City: Postal Code: Parent/Guardian Information: Is this the primary contact person? Yes No Parent/ Cell# Guardian Name: Work# Relationship to Client: Address same as above? Yes City: No Home# Postal Code

24 . How did you hear about us?. Are you currently or have had counseling at Sudbury Child and Family Center? 6a. Are you (caregiver) at risk of harming yourself or others? 6b. Is the child/youth at risk of harming her/himself or others? Yes Yes Yes No No No IF yes to either 6a or 6b, please explain: 7. What is the primary, or most important concern that has brought the client here today? (Please provide details) : 8. How long has it been a concern? - weeks 6+ months - weeks - months - months Medical History: 9. Is the client on medication?: Yes No 9a. If on medication, what type of medication? : 0. Has the client been diagnosed with a mental health disorder?: Yes No

25 . If diagnosed with a mental health disorder, what was the diagnosis (please identify all mental health disorders if more than one is present)?. Does the client have a physical disability?: Yes No a. If yes, what kind?:. Does the client have a Developmental or Intellectual disability?: Yes No a. If yes, what is the disability?: OFFICE USE ONLY File Closure: File Closed Mobile Crisis CIMS# SDQ Complete with CIMS number

26 Solution-Focused Brief Therapy (SFBT) Clinician Questionnaire Question Frequency. How often do you discuss the Solution-Focused Brief Therapy approach in supervision? Never. To what extent does your work focus on client problems? Never. How often do you use scaling questions with your clients? Never Never Always Always Never Always Never Always 7. How often do you use coping questions which seek to identify how the client copes with setbacks or ongoing difficulties? Never Always 8. To what extent does your work focus on finding solutions? Never Always 9. How often do you use direct compliments to reinforce identified progress (eg. I m so impressed with that ) Never Always 0. How often do you use indirect compliments to reinforce identified progress? (eg. Wow, how did you do that?) Never Always. How much agency support do you perceive to have around using SFBT? None All I need. How comfortable are you using Solution-Focused Brief Therapy? Not at all Very. To what extent does your work focus on clients future or personal goals? Not at all. How able are you to intervene with clients using SFBT? Never Always. How effective are the techniques that you use with clients when offering SFBT? Ineffective Effective 6. How able are you to meet the needs of clients using SFBT Unable Very able. To what extent does your work focus on clients strengths and resources?. How self-assured do you feel in delivering brief services using SFBT? 6. How often do you use the miracle question or the preferred future question with your clients? Always Always Very Date Completed: ID:

27 Solution Focused Brief Therapy/ Meeting Tracking Sheet CORE COMPONENT FREQUENCY. Used miracle question Yes No. Used scaling questions Yes No. Gave compliments (Indirect or Direct) Yes No. Looked for strengths/ solutions Yes No. Looked for exceptions to problem Yes No 6. Set goals based on solutions Yes No 7. Assigned homework tasks Yes No Took consulting break Yes No SESSION REMINDERS: EARLY SESSION: Ask about pre-session change, have some problem-free talk MIDDLE SESSION: use coping questions, scaling (goal/ optimism/ effectiveness of session), here-and-now oriented, client as expert, encourage mindfulness END SESSION: Future-oriented, wondering, make suggestions Date Completed: Staff Name: Client CIMS ID: 6

28 Sudbury Child and Family Center Walk-In Service Single Session Impressions & Feedback Tool (SSIFT) Adapted Version Name Date Please share your feedback. Please circle the appropriate number to indicate your experience of today s conversation Agree with this side Neutral Agree with this side FOCUS My therapist focused on what they wanted to and my wishes didn t seem important My therapist addressed what I/we wanted to talk about the most The conversation captured and held my interest My therapist learned about my skills, abilities, and wisdom I experienced being an important partner in our work together today INTEREST The conversation was uninteresting to me YOUR SKILLS My therapist did not learn about my skills, abilities, or wisdom PARTNERSHIP I felt left out of the work today FEEDBACK 7

29 My therapist kept going without checking in with me My therapist asked for my feedback throughout the conversation I played a large part in developing the plan and next steps I felt hopeful after the conversation The conversation was useful PLANS/ NEXT STEPS I played no part in developing the plan and next steps HOPE I felt hopeless after the conversation USEFUL The conversation was not useful What are one or two things that stood out for you in the conversation that were useful and will stay with you when you leave?... What would have made your visit better? Adapted from Scot J. Cooper Brief Narrative Practices Project, Canada (web site) 8

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33 APPENDIX SUSTAINABILITY & KNOWLEDGE EXCHANGE PLAN DRAFT PROPOSAL GOAL: To sustain our efforts in delivering solution focused brief therapy across core services and enhance the use of evidence informed practices within the Agency as our PACE funding ends. ACTIVITIES LEADERSHIP Training in Implementation Science for Managers Transformation of PACE Core Team into Continuous Improvement Committee DATE OF COMPLETION PROGRESS MEASURE PERSON(S) RESPONSIBLE March 0 Training Modules PACE Team RESULTS/COMMENTS PACE Workshop December 0 Scheduled Meetings (minimum quarterly) PACE Team December 0 Lead role is identified and hired Senior Management Training Modules accessible on shared drive for all staff PACE Team Identification and Maintenance of EIP Lead Role for Agency CAPACITY BUILDING Development of a Core October 0 Training for new staff on research, program

34 evaluation, implementation science, & logic models Development of Community of Practice October 0 Schedule of meetings/minutes PACE Team Bi-Annual training on research, program evaluation, implementation science & logic models January 06 Training/Workshop delivered PACE Team Bi-Annual Training on SFBT (Refresher) January 06 Training/Workshop delivered PACE Team March 0 Meetings/Minutes Core Service Delivery Framework Committee January 06 Meetings/Minutes Continuous Improvement Committee comprised of Sr. Mgt; Mgt.; Staff; Service Development Core Service Delivery Model framework development Annual service development review meetings to develop/review logic

35 models, program outcomes and stakeholder feedback Stakeholders Full implementation of SFBT across multiple services within the Agency January 06 Revision of clinical policies and procedures for alignment with new service framework January 06 Knowledge Exchange Activities Sustaining Communities January 0 Ongoing of Practice Supervision Tool & Clinician Questionnaire Revised Policies and Procedures Management and Staff Continuous Improvement Committee Meetings/Minutes EIP Champions Partnership with Other Agencies for Knowledge Exchange January 0 Ongoing Meetings/Minutes Management and Staff Professional Development opportunities January 0 Ongoing Identification of opportunities for learning, attendance to workshops/conferences /webinars and presentation to all staff Management and Staff

36 Annual review of policies and practices to support learning organization January 0 Ongoing Updates policies and procedures Development of Internal Agency Conference Committee October 0 Meetings/Minutes Annual Agency Conference April 06 Ongoing Lunch and Learn April 06 Ongoing Continuous Improvement Committee CFC Conference Committee Internal Conference led by Staff CFC Conference Committee Lunch and Learn Opportunities led by Staff Management and Staff Agency-wide access to online journals and databases Lead EIP and IT Communication and Staff Engagement Sustainability of Internal January 0 Communication Plan Staff Meetings/Huddles Management Presentation to Board, Completed Presentation Director of Clinical Access to Online Databases/Journals April 06 Ongoing January 0

37 Management and Staff of EBP Outcomes / Agency Outcomes Presentation of Sustainability Plan Services; PACE Team; Management March 0 Completed and Approved Sustainability Plan and Presentation PACE Lead Administration of January 06 Evidence Based Practice Attitudes Scale (EBPAS) Monitoring and Evaluation Enhanced utilization of Ongoing BCFPI and CAFAS into assessment, formulation and service planning in new web based format Completed Survey Continuous Improvement Committee Program improvements informed by and aligned with outcome measures Director of Client Services and IT End User Continued use of Clinician survey on SFBT Supervision Program improvements informed by and aligned with process measures Supervision Tool and Checklist Ongoing Ongoing Addition of Agency-wide outcome measures that January 0 support brief service delivery Program improvements informed by and aligned with outcome measures Annual Review of Evaluation Plan for Core Review and revision of January 06 Continuous Improvement Committee Clinical Managers and Staff Continuous Improvement Committee 6

38 Services Finance Senior Management & Board Review of financial allocation of EIP and EIP Sustainability Plan Training Budget allocation designated for EIPs Evaluation Plan for Core Services Continuous Improvement Committee March 0 Completed Plan with Senior Management, Direction communicated Board, Finance to staff March 0 Training Coordinator identified for EIP training opportunities Senior Management 7

39 APPENDIX Communication Plan for SFBT/PACE (Next month) April 7-, 0: Communique # sent from the PACERS (attached). Initiates discussion of upcoming training and plants seed of training in June (&). Also introduces Fidelity of practice and links back to other trainings (ie. MI). April -8, 0: Communique # (April or th) Reminder of Presentation at All Staff and to invite them to think about SFBT and how they would like to be involved so we can get feeback. Presentation at All Staff Mtg April 6th (there will be a game and I am hoping to have a handout about PACE. ) Context: Kelsey ) What Have We Done?: Marieve ) What s Happening Now?: Pam ) What is Coming Up?: Melissa This will set context for upcoming training and follow-up from Needs Assessment results completed in December 0. The goal is to reinforce upcoming training and plant the seed. April 8th: Communique # Follow Up to presentation at All Staff via with contest as well as thanking for their participation at the All Staff. Inform of upcoming Weekly s and contests. April -, 0: Communique # via further discussion of Upcoming Training opportunity. April 8-May,, 0: PACE Core Team Meeting (April 8th); Agenda: ) Review evaluation framework and logic model in relation to Training so appropriate revisions can be made to improve outcomes. ) Discuss potential tools and measures for data collection Ongoing Communication Plan:. Establishment of Communication Committee for PACE (Done). Communication Committee prepares weekly s to staff to keep them apprised of PACE Activities and to continue preparing them for training opportunities. s will include contests with prizes to assist with staff engagement. Everyone s name who submits an answer will go into a draw on Wednesdays for a $.00 coffee card.. Project Lead reviews all communication s for dissemination Fridays each week from the PACERS. 8

40 . Informal Face to Face communication occurs by all PACE members with staff at any opportunity to explain the project and answer questions. A handout will be prepared so that people have something to refer to when they hear PACE.. Newsletter publications will be prepared for each edition. NOTE: There must be at least 0 communications to staff between All Staff and June & training so we may need to come up with some other opportunities. This can be reviewed by the Communication Team. 9

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