Implementation

1
Implementation Sustainability of a Parenting
ProgramBuilding Organisational Capacity

• Karen Myors
• A/Prof Virginia Schmied
• Professor Edward White

2
Outline of Presentation

• Background to study
• Triple P
• Child Family Health Nurses
• NSW Parenting Program for Mental Health
• Strategies for implementation sustainability
• Limitations of study

3
Background to study

• Acknowledgements
• Qualitative study
• The Positive Parenting Program (Triple P)
• Data collected 2002 2005
• 2 metropolitan AHS
• Focus groups interviews
• 48 nurses
• Semi-structured interviews
• 8 NUMs
• 5 background informants
• Observations of clinical interactions
• 20 mothers their children with nurses
• Review of documents

4
Triple P

• The Positive Parenting Program
• 5 levels
• This study
• Level 2/3 Primary Care
• Level 4 Group
• New addition
• Level 2 Selected - Seminar Series

5
CFH Nurses

• Model of wellness, primary health care
• Children - birth 5 years
• 2001 survey
• 90 of parents/carers had attended a CFH clinic
• (NSW Health, 2002)
• 2005 survey
• 45 years average age
• CFHN 3rd oldest nursing group
• gt ½ of these nurses worked part time
• (Australian Institute of Health Welfare, 2008)
• Participants in study gt 1/3 CFHN for 16-35
  years

6
NSW Parenting Program for Mental Health

• 1998 2003
• Provision of training in parenting programs
• Triple P
• TIPS
• Coordinators in each Area Health Service
• 1,196 workers trained in Triple P 2000 2002
• Majority of the participants CFH Community
  nurses - 330

7
NSW Parenting Program for Mental Health contd

• Impact of training
• ? confidence in conducting parenting
  consultations
• Positive impact on service delivery
• June 2001 Dec 2002 gt3966 parents accessed
  Triple P
• Ongoing in clinical consultations

8
However .

• Despite these positives
• Barriers to implementation sustainability
  existed

9
Effective consultation

• To me it seems that we chug along on our own
  then periodically, some Government Aide or
  somebody, gets an idea and theyll just say,
  what can we do, hah, Early Childhood, well give
  them a bit of training and well shove them out
  there, really thats how its been going. Its
  just hotch potch (FG437)
• I didnt even know what Triple P was for a long
  time (FG561)

10
Planned implementation

• At the same time we were rolling out home
  visiting started focusing on home visiting
  Triple P just got forgotten about (NI14)
• Then Family Partnership training was implemented
• Triple P Centre for Mental Health
• Home Visiting Family Partnership Primary
  Health Care Branch

11
Ongoing support - managers

• And that budget, let me say, has been the same
  for the last ten years, its never ever changed,
  ten or even longer. So weve always had that same
  number of full time equivalent nurses in the
  service and here we are doing more expansive
  things (MI15)
• Theres always been a very high expectation from
  my manager that they (Triple P groups) would be
  run, and that we would work out a way of doing
  them (MI63)

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Ongoing support managers contd

• It was just the practical side of things, when we
  went to send the people out to do the classes
  they restricted this. From that point of view I
  felt personally frustrated. And the other thing
  they didnt do was make it clear, to put it in
  writing, whether we could or couldnt do things,
  like pay penalties (MI12)
• The human resources are that were not going to
  get any more, so something gives there is a big
  commitment, theres a lot of preparation (MI47)

13
Ongoing support - clinicians

• Why cant we be given the time to run the
  groups? Its very frustrating for me (FG145).
• Id probably run more groups if they were better
  planned (NI43)
• I felt obligated to ensure that I take my time in
  lieu when its not busy. And I think thats a
  little bit unfair (NI43)
• The nurses continued to use the strategies in
  their clinic practice.
• Conflict with colleagues

14
Ongoing support clinicians contd

• Nurses felt devalued
• So much is expected of us that were scrambling
  all the time to keep up with everything (FG432)
• Most of our practice is that the client the
  clinic comes first we do the rest in our own
  time its very hard to get time off, very hard
  to get courses paid for (FG136)

15
Ongoing support clinicians contd

• Documentation
• Policy procedure manuals
• Clinical competency manual
• Operational manual
• Minutes of meetings

16
Ongoing support clinicians contd

• Reflective practice
• Case conferences
• 2002 nil
• 2005 nil
• Clinical supervision
• 2002 - nil
• 2005 - 1 AHS 3 Sectors
• Mentors role models were also important

17
Appropriately skilled workforce

• Training
• Accreditation

18
Available resources

• (We) were treated pretty shabbily We were really
  disgusted that we couldnt get the videos (NI14)
• ... We only have one (video) for our whole Area
  to use .. The follow up was really pathetic we
  were given all this wonderful information, we
  were supported We were enthusiastic (NI24) but
  no resources
• Mine (Triple P resources) are sitting in the
  cupboard behind you there (MI62)
• Accreditation

19
Lead professional

• I think for a lot of things in Health, thats
  what we do, we set ourselves up and do all these
  things that are whiz bang and wonderful and you
  need someone there to lead it on and keep the
  focus (MI36)
• NSW Parenting Program for Mental Health ceased in
  2002
• Coordinators still employed in some AHS

20
Lead professional contd

• Clinical Leaders
• Clinical nurse educators
• 2002 0
• 2005 0
• Clinical nurse consultants
• 2002 0
• 2005 1
• Nurse practitioners
• 2002 0
• 2005 - 0

21
End result

• 1st AHS wide implementation while coordinator
  employed
• Not sustained without a coordinator
• 2nd AHS full implementation never achieved
• Coordinator employed after initial training
• CNC heavily involved in other programs

22
Lessons learnt

• Effective consultation
• Planned implementation
• Ongoing support managers
• Ongoing support clinicians
• Time
• Recognition
• Documentation
• Reflective practice
• Appropriately skilled workforce
• Available resources
• Lead professional

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Limitations of study

• Small sample
• Only 2 metropolitan AHS
• The results may not be able to be generalised