Triple P Implementation Across Diverse Service Systems: Facilitators and Barriers

Transcription

1 Triple P Implementation Across Diverse Service Systems: Facilitators and Barriers Suzanne Kerns, Ph.D. Cheri Shapiro, Ph.D. Helping Families Change Conference Sydney, Australia February 20-21, 2014

2 The BIG FIVE Damschroder Consolidated Implementation Framework intervention characteristics outer setting inner setting characteristics of the individuals involved process of implementation Damschroder et al., 2009 Our Goal: Provide applications across early intervention, child welfare, and pediatric primary care

3 Facilitators and Barriers to Triple P Implementation in Early Intervention Systems Cheri Shapiro, Ph.D. Research Associate Professor Associate Director Institute for Families in Society University of South Carolina

4 Early Intervention in the U.S.A.

5 Why Stepping Stones Triple P?

6 SSTP and Early Intervention

7 Outer Setting Client needs and resources Risk Need or Want Provider assumptions about intensity External Policies Early intervention services individualized Parent training spread across multiple service categories

8 Inner Setting Structure of organization and work Single point of contact in EI system Double dipping? Many professionals provide services Who best? Relative priority of parenting services Learning Climate Good interest from 2 RCT s of SSTP in early intervention

9 Provider Characteristics EI s self report teaching caregivers Direct observation=working more with children Modeling with child parent skill acquisition Assumptions about client needs EI v. self-referrals in recent studies

10 Process of Implementation Planning Engaging Opinion Leaders Champions Formal implementation leader

11 Facilitators and Barriers to Triple P Implementation in Child Welfare Suzanne Kerns, Ph.D. Assistant Professor Division of Public Behavioral Health and Justice Policy University of Washington (Seattle, USA)

12 Child Welfare in Washington State Need for in-home services Pillars Safety Safety Permanency Wellbeing Families with complex needs Wellbeing Permanency Heavy reliance on FPS for services Contextual Pre-Implementation Paradox Have many EBP-trained providers with few referrals Have non-effective system (FPS) with plenty of referrals

13 Big picture context

14 The BFH Idea Could you imbed Triple P within the service system of choice Increase access to EBP Leverage strengths of FPS system Provide some additional supports to the safety pillar Supports including: Level 4 Standard Level 4 Teen Level 5 Pathways

15 The BFH Worry What if, instead of Triple P making the FPS service stronger, Triple P sinks to lowest common denominator??? Leveraging (or, pushing the limits of) the Adaptable Periphery

16 Outer Setting Integration with FPS is a way to support the cosmopolitanism of the intervention. Contracts structured to be more lucrative for agencies than services as usual

17 Inner Setting Structural characteristics: How to align with need for a scalable fidelity framework?

18 Creation of QA support Values: Minimal sufficiency Activate provider self-regulatory framework Scalable (relatively) Leverage technology Produce hospitable implementation climate Components: Post-implementation supports Monthly survey Monthly peer support Monthly consultation calls Teeth: Technical Assistance Plans Formal Improvement Plans

19 Considerations to Context Agency Readiness Assessment Pre-training webinar with providers Overview of Triple P Overview of QA approach Overview of contract implications Ingredients: Cases Compliance Competence

20 Component: Monthly Survey

21 Component: Peer Support Required to meet once monthly Use of PASS encouraged Can be in person (preferred) or via phone or Skype

22 Component: Consultation Call Required once monthly Via telephone conference call 6-8 providers/call

23 Toolkit Keeping Track of it ALL

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26 Initial Results The good: Faster scaling of Triple P than any other EBP to date High rate of competent providers (90%) Providers highly satisfied with Level 4 Standard and Teen The bad: Lower confidence/avoidance of Pathways The ugly: Some significant turnover impacting reach Strategizing peer support in lower resource areas (catch as catch can)

27 Facilitators and Barriers to Triple P Implementation in Primary Care Suzanne Kerns, Ph.D. Erin McCormick, MPH Andrea Negrete, MA Scott Waller, M.Ed., CPP

28 Intervention Characteristics Strengths Parenting supports viewed as highly relevant High value to evidence-based approaches Easy to use resources Challenges Provider disincentive to participate in training for Triple P Training time (esp problematic in rural clinics) Requirement for accreditation viewed with skepticism Uncertainty about how to fold into fabric of practice

29 Outer Setting Show me the Money! Current Procedural Terminology (CPT) billing codes identify appropriate codes for variances in time, initial vs. ongoing services System understanding of billing process

30 Sample authorization letter

31 Inner Setting Consideration of structural characteristics Time required for services Triple P = minutes/session Usual Care = 10 minutes maximum Schedulers need to anticipate Triple P sessions to manage physician schedules

32 Individual Characteristics Highly confident yet poorly trained You taught my residents more about behavioral interventions in this two day training than I typically can train them in two years as their preceptor Values Triple P Value: Offer Suggestions Physician Value: Offer Prescriptions Partial Solution: Train with medically-relevant metaphors

33 Process of Implementation Peer support for behavioral health foreign within US PC context Referral pathways Managing relationships with other provider agencies

34 Integration Ideas Carrots: Billing and reimbursement supports Training attendance credits(cmes) Increasing relevance: Medical metaphors during training For residents, ensure preceptors are also trained Consideration to context prior to, during, and post implementation

35 Common Themes CONTEXT CONTEXT CONTEXT Adaptability of Triple P favorable for flexible implementation Consider: Program Supports Implementation Supports

36 Questions? Thank you for your attention! For more information, contact: Suzanne Kerns: University of Washington, USA Cheri Shapiro: University of South Carolina, USA