While large-scale, multi-year projects are essential in advancing the work of child welfare and improving the overall health and well-being of children and families, the many moving parts and big teams can sometimes make the work feel a bit impersonal and hard to connect to. Even the most earnest of efforts to share details and insights can get lost over a project’s lifecycle.
The child welfare landscape should continually be injected with greater doses of research and innovation. With this in mind, the Quality Improvement Center on Adoption and Guardianships (QIC-AG) was launched to increase pre- and post-permanency stability for families.
I joined the QIC-AG team as a communications consultant as it was rounding out its third of five years and was charged with assisting with dissemination efforts and activities. It was immediately clear that the team was deeply committed to thoughtful planning and structured implementation, creating high quality and practical content, and openly sharing valuable insights of the efforts being made to increase pre- and post-permanency stability for families.
As I got more intimately involved in the work, I realized that while implementation science can feel cold and rigid, being grounded in and tethered to a sound process and structure was allowing for the very warm and personal work to shine through. The efforts in each of the eight QIC-AG sites followed a structured progression through the various phases of implementation science informed by the National Implementation Science Network (NIRN, 2010) and “A Framework to Design, Test, Spread, and Sustain Effective Practice in Child Welfare (Children’s Bureau, 2014).
The solid structure created the space for the team to be thoughtful and deliberate in their planning and execution and perhaps most useful, to reflect on the lessons learned along the way. Taking the time on the front end of the project helped each site to think through the many layers of implementation and execution and helped teams to clearly see what was working and what was not.
On July 31, 2019, the QIC-AG released its final Annual Lessons Learned webinar offering a deep and detailed look at bigger-picture themes that emerged as well as specific lessons (some learned the hard way) that were unique to individual sites. Here are some of the highlights.
Staffing Selection
It’s no surprise that one of the most powerful lessons that emerged was related to people and staffing.
The New Jersey site team invested time in developing an extensive, detailed staffing plan, including comprehensive recruitment procedures and selection process that was tailored to the unique aspects of the Tuning into Teens (TINT) project and needs of the target population. This included the development of detailed job descriptions that emphasized specific qualifications to ensure that facilitators had the ability to navigate the topics around adoption, kinship care and legal guardianship that might come up during the TINT sessions.
For the New Jersey site implementing TINT, the team’s deep investment in a staffing plan was ultimately able to secure a team of 20 committed, well-qualified facilitators.
Internal-External Stakeholder Engagement
Providing support to families calls for a complex network of government entities, private agencies and individual professional providers. Each component has policies, procedures and priorities that can make system-wide coordination clumsy and wholesale change difficult. As Vermont implemented its Permanency Survey, they were fortunate that stakeholder connections were already in place through the System of Care (SOC) delivery service areas.
When designing a new intervention in Wisconsin: Adoption and Guardianship Enhanced Support (AGES), it was crucial to get input from the people who were being served as well as those in and outside of the organization who would provide the service. Each stakeholder group brought unique perspectives and invaluable insights throughout the project cycle.
Coaching
Counselors need time, attention and experience through repetition to become adept and gain fluency in delivering an intervention. In Tennessee, the Neurosequential Model of Therapeutics (NMT) certification training was meticulously prescribed with many points of interaction with the purveyor, ChildTrauma Academy. Tennessee added more layers of support for the family counselors while they underwent the training to not only ensure they successfully completed certification, but also to ensure the family counselors helped families by adhering to the NMT model.
Logistics and Scheduling in Advance
Just as “concurrent planning” in case management is complicated, so is balancing the calendar and venues for training. In the course of delivering more than 20 series of Pathways 2 in Texas, the best practice that emerged was to complete the schedule for all class series as far in advance as possible to hit the enrollment goal. Without a confirmed schedule, staff conducting outreach had less time to encourage families to participate and less time for promotional materials to be mailed or distributed to families (e.g., Save-the-Date postcards and Register Now fliers). In addition, a longer lead-time allowed more opportunities for community partners to promote the intervention to the families they served.
Recruitment and Retention
If a family does not feel that they need what a program is offering, then they are unlikely to enroll. Therefore, the way a program or service is described is key to moving families to decide to participate. With Illinois’ TARGET, a strength-based, psycho-educational intervention, it was important to create awareness and motivation because the program is offered before families have started to experience the issues that can arise during their child’s teen years.
Thus, the message has to strike a tone that conveys, “Family life is fine for now, but TARGET could make it even better.” Even though the Illinois site team invested substantial time in developing the messaging, the team had to make changes based on the initial responses of parents/caregivers to the TARGET outreach message.
Anchor in Implementation Science
Catawba County, North Carolina, implemented Reach for Success, an early-outreach program designed to identify adoptive or guardianship families who might be at higher risk for post-permanency discontinuity or instability and may benefit from a “success coach” model of post-adoption services. The Catawba site team’s commitment to implementing Reach for Success using implementation science provided a solid platform for executing and evaluating the project.
Culture and Community Buy-In
Engagement often occurs only when families feel they are understood and respected as individuals. Early in the project, the Winnebago site team implementing Family Group Decision Making (FGDM) realized they needed to deeply understand the unique Ho-Chunk cultural attributes so they could ensure those attributes were reflected in the intervention. The Winnebago team selected an intervention model that closely aligned with the Ho-Chunk belief system. However, the site team went further to specifically align the model with Ho-Chunk language and culturally relevant assessment tools.
Whether part of the overall collective work or site-specific, there have been many key insights and lessons that have emerged from the work of the QIC-AG. The learning of these lessons is in large part because of the structured and methodical approach of the project from the beginning. Many of the lessons will have great value broadly for the field as well as more specifically for families. What stands out the most however, is the team spirit of the people who brought this project to life.
Reports containing all of these lessons by site can be found on the QIC-AG website and are all part of the team’s continued commitment to elevate the work for children and families and improve adoption and guardianship preservation and support. Detailed evaluation reports are planned for later this year.
April Dinwoodie is a transracially adopted person and host of the podcast “Born in June, Raised in April: What Adoption Can Teach the World!” Click here to read all of Dinwoodie’s in-depth profiles of the QIC-AG projects.
The National Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG) is a five-year cooperative agreement, funded through the Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, designed to promote permanence when reunification is no longer a goal and improve adoption and guardianship preservation and support. For more information about this project, please click here.
