Parent Management Training Oregon
Model-Change Management Challenges
Netherlands
January 2006
Jim Wotring
[email protected]
1-1-517-241-5775
Michigan’s Initial Reaction to
Evidence Based Practices
“When pigs fly, I’ll provide an evidence
based practice”
Some Staff Reaction to Change
Change Ha-Ha-Ha
Broad Participatory Planning
• Committee Identified Potential Evidence
Based Practices
• Committee Reviewed Outcome Data
and Made our Decision Using Data
– Data Helped Create a Sense of Urgency
• Committee Selected PMTO as our
Primary Evidence Based Practice
Client Types
(Hierarchical, Based on CAFAS Profile, & Obvious at Intake)
Thinking Problems
Maladaptive Substance Use
Self-Harmful Potential (includes severe depression)
Delinquency
Behavior Problems with Moderate Mood Disturbance
(Beh Prob =School, Home, Or Behavior Toward Others)
Behavior Problems without Mood
Moderate or Mild Mood and/or Mild Behavioral Problems
CAFAS Tiers®
Hierarchical Client Types
Thinking
Maladaptive Substance Use
Self-Harmful Potential
Adolescent
Specialties
Delinquency
Behavior Problems with Moderate Mood Disturbance
Behavior Problems without Mood
Moderate Mood
Mild Behavior or Mood
Client Types for Youths with SED Served
by Michigan Public Health
M oderate/
Most Common
Client Types
(50.4%)
Behavior Problems
•in School,
•at Home, &
•in Social
Interactions
M ild M ood
and/or M ild
Behavior
Behavior
Problems
25.3%
Problems
4.1% *
Thinking
M aladaptive
Problems
Substance
6.6%
Use
6.8%
SelfHarmful
Potential
Behavior
Problems
with M ood
25.1%
17.8%
Delinquency
14.3%
Which EBPs could help the most youth?
Adjustment
or Moderate
Mood
18%
Behavior
17%
Parent
Management
Training
(PMT)
Thinking
Problems
8%
Substance
Use
7%
Cognitive
Behavior
Therapy for
Depression
(CBT)
Self-Harm
17%
Behavior
With Mood
20%
Delinquent
13%
From Evidence-based Treatments for Children
And Adolescents: Matching CAFAS Profiles
to Treatment Types. Hodges, 2004
Percentage of Youth Not Improving on each CAFAS
Subscale: The Impetus
60%
% Not Improving
50%
40%
30%
20%
10%
0%
Home
School
Behavior
Toward
Others
Moods
Community Substance
Use
CAFAS Subscales
Thinking
Self-Harm
Percent of Youths with Behavioral Impairment in the LOF Dataset for the
Period of 2000-2004 (N= 16,767)
100%
95%
93%
95%
91%
90%
Percent of Youths With Impairment (%)
PMTO target
cases
80%
70%
66%
65%
64%
67%
60%
Severe,
moderate or
mild
impairment
50%
40%
Severe or
moderate
impairment
35%
38%
37%
33%
30%
20%
10%
0%
All youths
6-8 year olds
9-11 year olds
Age
12-17 year olds
Initial Implementation
• Change Management Strategies (Core
Planning Activities at State and Local
Level)
• Theory of Change Plan-Logic Model
(Collaborative Planning Process)
• Work Plan (Collaborative Planning
Process
Created a Sense of Urgency
Action: Urgency
Action Taken
•A sense of urgency
had to exist or be
developed (we used
data, consumers, a
mental health
commission report,
and conference etc..
•Director described need for
evidence based practices
•Partners formed an large
planning committee
•Partners (CMH/ MDCH)
held a conference to
highlight need for change
•Clear direction from State
Behavior Observed
•People described why we
need to change based on
new information (or quit
talking to me).
•We used outcome data to
help staff become more
aware of their need to
change and external
environment (high drop out
poor outcomes easy
behavior disorders.
Behavior to
observe
•People say to each
other lets go we
need to change
things.
Test: Within our
organization:
•Individuals asked
challenging questions
about why change
now? Why do we need
to provide evidence
based practices
•People developed a
sense that they needed
to change?
•They became more
aware of their external
environment? Mental
Health Commission
helped with this.
Your Sense of Urgency May
Be
• Operatie Jong (Operation Young) to
Strengthen Youth Care System
• Wet op de Jeugdzorg en Bureau Jeugdzorg
(CW, MH, CP)
• Behavior Disordered Children from Juvenile
Detention Centers Being referred to Ministry
of Health, Welfare, and Sport
• Poor Effectiveness of Current Interventions
for Behavior Disorder Children
Built our Leadership Team
Action:
•A guiding team had to
be formed at a State
and Community Level.
•They have to be
credible, have the skills,
connections,
reputations, and formal
authority to get the job
done.
•They have to be a
powerful enough group
Behavior to observe:
•The group works well
together and shows
enthusiasm.
Action Taken:
•Formed
committee with
state, community
& university
representatives
•Committee
became
emotionally
committed to the
change process
•Informal leaders
on committee
inspired others
Behavior
Observed:
Groups work well
together and
problem solve
Test:
•Does the team:
Consistently get the
resources they need
to get the job done
•Motivate and
inspire others
•Maintain a
consistent approach
and direction.
Leadership
• Never forget that only dead fish swim
with the stream
– Malcolm Muggeridge
Team Competency Influence
Team Competency-A useful tool to help the team determine if they have the right
team members relative to the competencies and influence necessary to execute
the initiative.
Competency
/Influence
Team Member
H=High
M=Medium
L=Low
Helps in forming team and in making adjustments to the team. Can be used at the
beginning of the project and after if the project is struggling due to lack of competency or
influence.
Team Competency Influence
Team Competency-A useful tool to help the team determine if they have
the right team members relative to the competencies and influence
necessary to execute the initiative.
Team Member
Competency
/Influence
Understands
Need for
Evidence
Based
Strong Agency
Leader
Strong
Sponsor to
support system
change
Political
support for the
system change
Informal leader
among peers
Strong
University
leader
H=High
M= Medium
L=Low
Helps in forming team and in making adjustments to the team. Can be used at the beginning of the project
and after if the project is struggling due to lack of competency or influence.
Created a Shared Vision/Mission at a State and
Community Level (Logic Model)
Action: Vision
•Are the vision and
strategies clear.
•Is the vision
simple, clear and
uplifting
Behavior to
observe:
The developed
vision and
outcomes are
shared
Action Taken:
•Clear simple
vision and
outcomes
described in
documents
•Outcomes are
clear and
measurable
Behavior
Observed:
Logic model
completed
Test:
•Do you know what
the vision outcomes
are?
•Is it compelling
and desirable?
•Can most people
who will be effected
by the change
articulate the vision
and outcomes?
Parent Mangement Training Oregon - Logic Model
Goal: Improve Child and Family Well Being by Increased use of Evidence Based Practice and Outcome Management
System Context
Presidents new Freedom Commission
Michigan Mental Health Commission
Federal Mandates-Science to Service
Balanced Budget Act
MDCH Vision and Mission statement
MACHMB Resolution Statement
Resources
Staff Time
Federal Block Grant
State funding
Federal Grants
Foundation Funding
Action Steps
Assumptions
PMTO will improve services to children
and families
Families will like PMTO due to improved
functioning (less calls, less missed
work) and this will have a positive
impact on home, school, and community
Treatment will positively affect other
family members
A manualized treatment will make it
easier to train new staff and retain
current staff
PMTO will enhance the current array of
services
∙
PMTO can be used across the array of
services (Outpatient, Home-based, and
Groups)
PIHPs will work with MDCH and
problem solve as training is provided
Infrastructure will be developed at the
state and PIHP level that includes
organizational, utilization management,
and performance measurement
There will be strong leadership/
partnership with state and PIHPs
Data will be gathered to monitor fidelity
and outcomes
Education/ Awareness
Develop awareness through the
MACMHB Conference
Share information with stakeholders
Share information with Children’s
administrators at regular meetings
Share information about training at
conferences
Share information with family members
Family Involvement
Ensure that families are involved
throughout planning and implementation
Involve families in the evaluation of data
and sharing outcome information
Training and Technical Assistance
Purchase equipment needed for training
that includes: 1) DVD video camera, 2)
tripod, 3) wide angle lens, 4)\ separate
michrophone, 5) computer with internet
access
Identify staff to be trained
Identify cases to use in training(minimum
of 5)
Provide training to participants in use of
video equipment
Provide training in data collection
Provide training in PMTO
Complete a minimum of 3 training cases
Provide ongoing feedback to trainees
PIHP staff begin training others
Develop a training and TA manual
Put training and TA material on list serve
Identify and distribute criteria for
certification
Develop in state capacity to train and
FIMP (virtual institute)
Families will receive training in PMTO
Families will provide training in PMTO
ACMH will provide training in family
involvement/engagement/welcoming and
choice in service selection
Action Steps
Administrative
Complete Institutional Review Board
requirements
Identify HCPCS Codes/Modifiers
Complete RFP Selection Criteria and provide
to CMHSP/PIHP
Complete contracts with PIHP’s
Develop new job descriptions that include
PMT training
Develop practice guidelines and utilization
management standards for statewide use
Integrate outcome management, PMTO and
MDCH site review processes
Include requirement to train staff in PMTO
and have available in MDCH/PIHP contract
Integrate families into administrative and
evaluation decision making
Develop plan to interface with juvenile justice
and child welfare
Insure PMTO is delivered in a culturally
competent manner
Funding
Apply for R-34
Apply for R-01 Grant
Make Mental Health Block Grant funds
available through RFP
Identify funding at CMHSP/PIHP level
Develop new contracts with EMU and OSLC
Measurement
Support families in evaluation/measurement
Expand LOF project (requiring participation)
Provide education and training on the
CAFAS and ensure that rater’s are reliable
Develop clear process outlining what data is
collected when and by whom
Develop a feedback loop to inform
participants about the process, fidelity, and
outcomes
Use data to inform decision-making process
Identify improvements in the model
Monitor Fidelity
Develop Michigan Fidelity monitors
Strategies
Build Awarness and Support
Build Infrastructure
Provide Training
Evaluate
Provide Feedback
Improve Training & Services
Outcomes
Measurement
PMTO will be implemented
statewide with model fideliy
FIMP
Improved child and family
functioning
CAFAS
Improved family satisfaction
with services
Family Satisfaction
Session Scale
Improved Parenting Skills
Caregiver Wishlist
Skill building Planner
Improved staff skills/
competency in PMTO
FIMP
Communicated the Change Plan
Action:
Communication
•Have you
communicated the
vision and
strategies in simple
heartfelt messages
•Have you
completed the
elevator message.
•Are people buying
in and telling you it
is a good idea.
Action Taken:
•Provide Regular
Communication to
Director and state
and local level
implementation
teams
•Update on PMTO
regularly at
conferences
•Need to plan
press releases
•Readiness
Checklist
Behavior
Observed:
•PMTO discussed
at committee
meetings
Test:
•Do you provide
timely
communication to
superiors?
•Is it simple short
and heartfelt?
•Do you discuss the
vision and
strategies in
regularly scheduled
team meetings?
Empower Action Lead-Lead-Lead
Action: Empower
action:
•Leadership has to
be willing to remove
barriers to action
•Leadership has to
give a strong dose
of empowerment to
support the initiative
•Key obstacles have
to be removed.
Behavior to
observe:
•More people fell
able to act and do
act on the vision.
Action Taken:
•Strong
leadership from
MDCH and
CMH’s has
helped lead the
change
•Providing
leadership
training
Behavior
Observed:
•Leadership
continues to
plan for &
support change
Test:
•You observe
recognition and
reward systems that
inspire and promote
change
•Supervisors are
actively trying to
remove barriers,
change behavior,
and build self
confidence
•New ideas are
being proposed and
tested
Leading Change on a Good Day
Leading Change on a Bad Day
Short Term Wins
Action: Short term
Wins
•Identify and accomplish
short-term wins. These
provide credibility,
resources, and
momentum for the effort.
•Guards against the
cynics and skeptics.
Behavior to observe:
•Momentum builds from
short- term wins and
fewer resist change.
Action Taken:
•Identified
additional
funding to
support local
leadership
teams.
•Providing
PMTO Training
•Providing
Leadership
Training
Behavior
Observed:
Training
Provided
Test:
•You can observe
quick results that are
made visible to all.
•Leaders use quick
results to
demonstrate
progress and share
with others
•People recognize
and celebrate
success
•People want to be
part of the change
effort
Short Term Wins Make Change
Easier
Wave of Change after Wave of Change
Action: Don’t let up:
•Push for wave of
change after wave of
change until done.
•Don’t let up, don’t
quit too soon and
don’t get bogged
down.
Behavior to
observe:
•People get on board
and go with wave
after wave of change
and start surfing
Action Taken:
•PMTO training
initiated
•G1,G2,G3
•Leadership
training initiated
•Federal grants
awarded
Behavior
Observed:
•Staff enjoy the
training
•New leaders are
developing
Test:
•Are new projects
being launched?
•Are leaders seeking
new situations to
further change effort?
•Are leaders seeking
to end the initiative too
soon?
•Evaluation results are
being shared to
support more change.
Creating a New Culture
Action: Making
change stick:
•Create a new
culture to make the
new behavior stick
•Nurture the new
group norms and
behavior through
recognition,
promotions, etc.
Behavior to
observe: New and
willing behavior
continues despite
pulls backward.
Change sticks
Action Taken:
•Staff compare
old outcomes to
new outcomes.
•Researching
new ways to
fund evidence
based practices
Behavior
Observed:
Test:
•Are people seeking
to understand what
they need to do to fit
in with the new
environment?
•Do people use old
habits, “ways of
being,” to describe
the new way of
being?
•Are change leaders
gaining more
influence in the
organization?
10
10
10