• By Dartington SRU
  • Posted on Tuesday 01st November, 2011

Making wider use of what works #2 #2

While prevention science can define what works in improving child outcomes, knowing how to widely implement effective interventions in an economically and politically tumultuous and fragile context are probably best answered by understanding how policy makers have made it happen. Karen Foley-Schain and associates from the Children’s Trust Fund of the Department of Social Services in the State of Connecticut, USA, describe in the latest edition of Child Abuse and Neglect, three key elements responsible for taking an evidence-based home-visitation program from two to 42 sites in a decade. The first step, says Foley-Schain, was the need to educate state legislators about the benefits of home-visitation for vulnerable first-time mothers. The Children’s Trust first led a concerted campaign of training and education of key influential state legislators to get the home-visitation program off the ground in the first two sites. They then gained the support of key community leaders and service users to advocate for expansion and to ensure that funding would be provided, increased and sustained. As described by Foley-Schain, “key to the Trust Fund’s legislative strategy was linking a program site to each of the state’s 29 birthing hospitals”. Demand for service delivery was driven by those sites providing services, rather than being imposed upon them. Second was developing a strong research and evaluation capacity. Right at the outset the Children’s Trust had a strong partnership with a local university. Their charge was to routinely collect outcome data to assess program effectiveness, to conduct qualitative research to understand barriers and catalysts of effective program delivery, and to undertake quality assurance audits of specific sites and network as a whole. As described by Foley-Schain and colleagues, “the information collected by the researchers was used to develop a better understanding of the program and to make changes when needed.”In one instance, for example, qualitative research found that the program was working with four main groups of mothers - those with cognitive impairments, the very young, those that were socially isolated, and others in a context of enduring crisis. The researchers stated: “These findings made it clear that a ‘one size fits all’ approach to services was not appropriate”. In response, caseloads were determined by a weekly home visiting schedule based on the needs of families rather than visiting a fixed number of families. The third critical element of ensuring the programs wider application was the development of an infrastructure or organisation charged with addressing the issues identified by research, interpreting data and informing policy. To this end, the trust fund established the Continuous Quality Improvement (CQI) Team. This comprised elected representatives from the trust fund, the program delivery team and the research team, each on two-year appointments. This body acted as a “mini-congress”. Foley-Schain and colleagues say that the CQI Team scrutinized the research findings “to bring new ideas and innovation to the program by keeping it dynamic and responsive to the challenges involved in home visiting while maintaining fidelity to critical areas of the program”. It was this intersection between legislative pressure, research and continuous quality improvement and fidelity monitoring that supported the wider implementation of home-visitation from two sites funded by $300,000 to 42 sites supported by a $10million investment. The challenge, in these crippling economic times, is to hold a steady course through the storm and maintain these levels of service provision. Once the storm has passed expansion will again resume. References:Foley-Schain, K., Finholm, V., Leventhal, J. (2011). Building a statewide home visiting program from 2 to 42 sites: A state agency’s perspective. Child Abuse and Neglect. doi: 10.1016/j.chiabu.2010.12.008

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