Implementing Skill-based Intervention in Child-Welfare Services (CWS) in North of Norway: Enhancing Family and Community Involvement

The aim of implementing is to improve quality of services provided by the Child Welfare Services (CWS) by implementing skill-based training and systematic evaluation with well-documented instruments. The goal is to improve long term mental health, general well-being and sustain able care of children in the protection of the CWS and reduce need for placement at institutions. The Care- and Developmental model in the northern region was developed by Bufetat region north, University of Washington (UW) and the Region center for child and adolescent mental health. The model consisted of several modules: 1) Evaluation with standardized instruments, 2) user-involvement, 3) Skill based-training based on cognitive behavioral principals, 4) Transition interventions and 5) Routines for practice. The goal of the implementation was to teach the youth and their families sufficient skills to strengthen life-quality and reduce placement at institutions by giving the youth and their families support and guidance in their home environment, during their stay at the institution as well as the transition between institution and home environment including foster homes. To strengthen the implementation process training, supervisor and ongoing leader support was highlighted. This research project aimed to study which factors had been important in achieving successful implementation of new practice and sustainment of new skills such as organizational factors, leadership behaviors, provider attitudes, belief in the intervention, and essential implementation leadership. based on reports from residential care professionals the results from this study indicated that: 1) relation- and task-oriented factors were more important than change-oriented implementation leadership behaviors, 2) dedicated time, organizational resources and workforce characteristics promoted implementation while factors such as negative attitudes, structural and procedural challenges and task demands acted as barriers for implementation, and 3) the intervention led to significant improvements in goal directness, increased leader support, and increased competence and fidelity after 3 years.

Data var innhentet fra ansatte ved barnevernsinstitusjonene som implementerte Helhetlig Støtte System (HSS) i region nord i perioden 2011-2015. Intervensjonen førte til betydelige forbedringer i målrettet, økt lederstøtte og økt kompetanse og troskap, noe som antyder at intervensjonsfaktorer med fokus på systematisk trening og veiledning er nødvendige. I tillegg, ble ansatte intervjuet om deres syn på effektiv lederstil. Intervjuene har bidratt med å øke kunnskapen om hva slags lederegenskaper som virker i institusjonskontekst og om hvilke faktorer som er viktig for å gi bedre omsorg. Dessuten, økte en målrettet innsats på personal og ledelsesnivå sannsynligheten for kvalitetsheving i tjenestene. Alt i alt, var målrettet adferd og positive holdninger nøkkel til vellykket implementering av HSS.

Project Summary The implementation project is a part of a larger international collaboration designed to improve long term mental health, general well-being and sustainable care of children in protection of the Norwegian Child Welfare Services (CWS). The study is based on the implementation of systematic cognitive behavioral module-based intervention called Multiple Support System (Helhetlig Støtte System, HSS) initiated in May 2011 designed to increase the standard quality of service in the CWS institutions in the northern region. The present study is looking at staff data collected over several years of implementing skill based cognitive behavior therapy (CBT) interventions in all state child well-fare facilities in the North of Norway. The large data set collected from staff at the CWS facilities between 2011-2015, has been strengthen with additional data from a questionnaire that was given to certified CBT supervisors at the Norwegian Association for Cognitive Therapy (NFKT) Supervisor Conference in November 2018. The questionnaire includes feedback from CBT supervisors from Norway including CBT supervisors from the CWS institutions in the Northern region. The aim of the implementation is to increase the quality of services by addressing the intervention at three user levels: 1) providing cognitive-behavior based skills training and standardized evaluation as the primary intervention for the children and families, 2) training and supervising staff at the facilities, and 3) implementing procedures for maintaining adherence and fidelity at the organization level. The study will look at questions addressing the organization and staff levels. Will improvement of 1) organization/management 2) skills-based competence and/or 3) goal directed behavior lead to higher goal directed behavior and job-satisfaction. The study evaluates staff data that are found important in achieving successful implementation and sustainment of new practice. The training and supervision in the implementation are based on a model for goal directed behavior and competence building through clinical supervision. We are looking at factors in supervision that could improve competence, adherence and professional attitudes in addition to the role of organizational readiness and leadership. We want to address questions such as: - What factors improves declarative, procedural and meta competencies in supervision? - Will improvement organization/management, skill-based competence and goal directed behavior lead to higher job-satisfaction and increased self-efficacy? The result will be published in a series of research articles in 2019-2020.