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Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
1
Transformation Facilitation:Developing and Evaluating a Model
For Intensive TA For States
Sybil K Goldman, MSWSybil K Goldman, MSWRachele C Espiritu, PhDRachele C Espiritu, PhD
LanLan T Le, MPA T Le, MPANational Technical Assistance CenterNational Technical Assistance Center
for Childrenfor Children’’s Mental Healths Mental HealthGeorgetown UniversityGeorgetown University
March 6, 2007March 6, 2007
Overview and PurposeOverview and Purpose
Description of TransformationFacilitation initiative
Overview of evaluation approach
Preliminary results
Challenges in evaluating intensiveTA
FeedbackFeedback
Transformation Facilitation:An Overview
VisionVision
Supporting leadersSupporting leadersin states andin states andterritories to achieveterritories to achievetransformation oftransformation oftheir mental healththeir mental healthcare systems forcare systems forchildren and theirchildren and theirfamiliesfamilies
TF Background
Unique model that encompasses a varietyof approaches (coaching, TA, knowledgeapplication (2005))
Individualized approach to supportingleaders in states and territories in theirtransformation processes
Response to CYF Division request forongoing, intensive support
Partnership between Georgetown,National Association of State MentalHealth Program Directors, and UnitedAdvocates for Children of California
Overview of TF
TF faculty team assigned to eachstate and territory
Entrée to state through the statedirector of children’s mental health
Individual, peer, and expertcomponents
Multiple modes of communication
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
2
Overview of TF
Management team supports internaloperations
– Protocols developed for first threecalls
– Tools developed to support process
Monthly meeting of TF providers toprovide on-going training andsupport and to identify commonchallenge areas
Evaluation component
Family Involvement in TF
United Advocates for Children ofCalifornia (the Statewide FamilyNetwork Technical AssistanceCenter)
Membership on the TF Team
Active participation and input via TFMonthly meetings
States/Territory involved in TF
Sybil GoldmanNeal HorenArizona
Conni WellsRachele EspirituVermont
Liz WaetzigJan McCarthyPennsylvania
Sybil GoldmanRoy PraschilNorth Carolina
Gary MacbethConni WellsNew Hampshire
David MillerEllen KagenMissouri
Roy PraschilSybil GoldmanMinnesota
Ellen KagenDavid MillerMaryland
Gary MacbethJoan DodgeIndiana
Roxane KaufmannLiz WaetzigFlorida
Rachele EspirituNeal HorenAmerica Samoa
TF PARTNERTF LEADSTATE/TERRITORY
Role of TF Team
Assess and identify
Help create an action plan and timeline
Facilitate strategic thinking about leader’s
activities and linkage to outcomes (assess
risk, leverage opportunities, explorepartnerships)
Provide process and content expertise
Continually assess change
Link to TA offerings & peer opportunities,
and content TA
Support ongoing evaluation of efforts
Characteristics of TF
Planful, relationship based,accountable, journey
Strategic
Flexible
Intensive
Individualized
Enhancing the knowledge andskills
TF Hats
Facilitator
Coach
Mediator
Connector
Technical Assistance Provider
Broker
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
3
TF Individual Work
Phase 1: Orientation and overview
Phase 2: Information gathering
Phase 3: Identifying and prioritizingchallenge areas
Phase 4: Strategizing anddoing the work
State Issue Areas
Ensuring forward momentum andprogress in transformation in aconstantly changing politicalenvironment
Obtaining meaningful family and providerengagement in the implementation ofan outcomes- and data-driven mentalhealth system
Transforming public mental healthservices, without new $$, using crossagency workforce developmentstrategies
State Issue Areas
Determining role in developing a strongfamily network, identifying keyactivities, and engaging families in thework
Engaging and empowering child andfamily teams as the primarydeterminants of services
Overcoming resistance and difficulty inmoving the mental health field toward apublic health model
TF EvaluationTF Evaluation
(Even if you can get a pig to fly,
it doesn’t count if you don’t measure it.)
Evaluation Activities
Phase
Pre-Project
Start-up
Implementation and ProjectModification
Maintenance and
Sustainability
Replication and Policy
W.K. Kellogg Foundation Evaluation Handbook (1998)
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
4
Evaluation Components
1. Process/Outputs
2. Utility and satisfaction
3. Impact
Preliminary ResultsPreliminary Results
Process/Outputs Objectives
Characteristics of TF states
To describe the TF sample
Implementation
To describe project andreasons for deviations
To document challenges andsuccesses in implementation
To monitor the extent of TAprovided
States/Territory involved in TF
Sybil GoldmanNeal HorenArizona
Conni WellsRachele EspirituVermont
Liz WaetzigJan McCarthyPennsylvania
Sybil GoldmanRoy PraschilNorth Carolina
Gary MacbethConni WellsNew Hampshire
David MillerEllen KagenMissouri
Roy PraschilSybil GoldmanMinnesota
Ellen KagenDavid MillerMaryland
Gary MacbethJoan DodgeIndiana
Roxane KaufmannLiz WaetzigFlorida
Rachele EspirituNeal HorenAmerica Samoa
TF PARTNERTF LEADSTATE/TERRITORY
States/Territory monthly contacts
2126State/Territory K
1-41812State/Territory B
1-71310State/Territory C
1-28.57State/Territory G
110.59State/Territory I
2-41611State/Territory A
243State/Territory E
13.29.5AVERAGE
State/Territory J
State/Territory H
State/Territory F
State/Territory D
STATE/TERRITORY
12416
11512
21210
112.59
Number
of people
Estimated
number of hrs
Number of
contacts
Process Implementation issues
Determining readiness
Developing the relationship
Doing the work
Handling transitions and continuity
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
5
Determining Readiness
Readiness factor in the state or territoryis critical [TF]
Early on, I was disappointed but now Isee it as an opportunity to collectthoughts, get feedback, logic model,supervisory experience [CD]
TF gives me credibility-I’m one of 10 states involvedin this national effort [CD]
Developing the relationship
Most important aspect of TF: Having anoutside mentor/consultant who didn'thave a preconceived agenda aboutwhere I needed to be or should be goinghas been wonderful [CD]
How you start is the lesson learned. TFis very much a relationship-basedjourney - very different from anexpert model [TF]
Start where your client is [TF]
Doing the work
Most important aspect of TF: Havingsomeone to discuss and brainstorm thathad no other competing agenda than to dojust that. [CD]
Have to be ready for chaos - the more youdo it, the more that you begin to recognizeit and know how to step back. [TF]
The national perspective hashelped – can use it to leverage thevoice for kid’s agenda. [CD]
Individual vs. team approach
Handling transition and continuity
Changes in States and CDs
Internal politics has a lot todo with how the processworks [TF]
Have to be ready for chaos -the more you do it, the morethat you begin to recognize itand know how to step back.[TF]
Utility and Satisfaction
Usefulness – How useful is TF?
Satisfaction - How satisfied are CDswith the quality of TF?
Utility and Satisfaction:Peer Retreat Evaluation Results
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
6
Impact/Outcome Objectives:Individual
Short-term outcomes:Increase in knowledge, skills, and attitudesIncrease in leadership developmentIncrease in supportIncrease in knowledge of resources andconsultantsIncrease in peer sharing
Intermediate outcomes:Identifies deficits and transforms systemstructure and processes
Long-Term outcomes:Individual’s goals for system reform are realizedChildren and families get the services they needChildren and families live, work, and play in theircommunities
Impact/Outcome Objectives:System
Short-term outcomes:States are aware of availableresources
Intermediate outcomes:Local supports are developedLinks across federal grants andactivities
Long-term outcomes:Affect the national transformationagenda for children’s mental health
Impact/Outcome Objectives:National TA Center
Short-term outcomes:Ability to identify new resourcesIncrease in knowledge of statesIncrease in family involvement
Intermediate outcomes:Increase in Center’s ability to bemore strategic in planning TA
Long-term outcomes:Increase in sustainable partnershipswith states and communities toprovide TAAffect the national transformationagenda for children’s mental health
Impact/Outcome Objectives:Data Collection Instruments
CD baseline survey
TF baseline survey
Peer to peer retreat evaluationform
TF contact logs & progressnotes
CD priority area log
1 year follow-up survey & keyinformant interview with CDs
Yearly CD and TF follow-upsurvey
Impact/Outcomes:Knowledge Increase
Impact/Outcomes:Leadership Development
Baseline survey question: Supportleadership development– Mean = 3.4 (4 point scale)
Follow-up survey questions willexamine specific pieces of leadershipdevelopment:– Increased awareness and knowledge of
role as an agent of change
– Adopted new knowledge to lead change
– Implemented policies to support systemtransformation
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
7
Impact/Outcomes:Peer Sharing
Baseline survey question: Assist with thefacilitation of collaborative alliances– Mean = 2.7 (4 point scale)
Impact/Outcomes:Support
Challenges
Methodological
Contextual factors affectingresults
Next Steps
Implementation and ProjectModification– Development of follow-up survey
– Continued review of process data aboutsuccesses and challenges to modifyproject
– Collect and use short-termoutcome data to refineproject
– Share short-term findings with
stakeholders
Further down the road
Maintenance and Replication– Continue to use evaluation to
improve the project and tomonitor outcomes
– Assess long-term impact
and implementation lessons
– Share findings withstakeholders
– Determine critical elementsof the project which arenecessary for success
Gathering Feedback
What experience or ideas do youhave about evaluating this model?
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
8
Questions or Comments
Contact Information
Sybil Goldman• goldmans@georgetown.edu
Rachele Espiritu• rce3@georgetown.edu
Lan Le• ltl5@georgetown.edu
Appendix:Appendix:Orientation to theOrientation to the
Framework of TransformationFramework of Transformation
Defining Transformation
transformation \n (15c) From theLatin roots to change TRANS(across) and FORMA (shape)
1. a change in form, appearance,nature or character
2. the process of doing so
The New Freedom Commission describedtransformation as a vision, a process,
and an outcome.
Defining Transformation
A continuous and complexprocess
New behaviors, new competencies
New sources of power
New partners
Profound changes in structure,culture, policy and programs
Will not happen over night
SAMHSA/CMHS
Transformation as a Strategy forInnovation
ContinuousSmall Steps
A focus oncore missions,improvingwhat thesystem isalready doing.
A series ofManyExploratoryMedium Jumps
Pushing theboundaries of corecompetencies,trying to createsomething newwithin the existingparadigm.
A Few BigJumps
New rule setsthat leveragenew ideas.
SAMHSA/CMHS
Georgetown University National TA Center
for Children's Mental 20th Annual RTC
Conference
Presented in Tampa, March 2007
9
Setting the Context for TF:Additional resources
Grounding our work
Setting the contextSetting the contextChange theory & frameworkChange theory & framework–– Tools for changeTools for change–– Dynamics of changeDynamics of change–– Leadership skillsLeadership skills
The Goals of aTransformation System
Goal 1 Americans understand that mentalhealth is essential to overall health
Goal 2 Mental health care is consumer andfamily driven
Goal 3 Disparities in mental health services are eliminatedGoal 4 Early mental health screening, assessment, and referral to services
are common practiceGoal 5 Excellent mental health care is
delivered and research is acceleratedGoal 6 Technology is used to access mental health care and information
Values and Principlesfor the System of Care
Comprehensive array of servicesIndividualized servicesLeast restrictive, most normativeenvironment that is clinicallyappropriateFamilies and surrogate families ofchildren are full participants in allaspectsIntegrated services with linkagesCase management
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC:
Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. Reprinted by permission.
Values and Principlesfor the System of Care
Early identification and interventionfor childrenSmooth transitions to the adultservices systemProtected rights of childrenServices sensitive and responsive tocultural differences and specialneeds.
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC:
Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. Reprinted by permission.
Change Theory & Framework
SOC is a Theory ofSOC is a Theory ofChangeChangeSAMHSA broadensSAMHSA broadensthe vision ofthe vision ofchangechange
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