New York Foundling O In 1869, three Sisters of Charity opened their doors to save the lives of

babies being abandoned on the streets of New York, beginning the tremendous legacy of The New York Foundling (“The Foundling”).

O Over the past 147 years, The Foundling has continued evolving from a respite home for abandoned children, to a comprehensive spectrum of community support services designed to support our mission of empowering children, families and adults to live healthy, independent, and fulfilling lives.

O Whether it’s an abused child in need of a foster home, a young mother who lacks the skills to care for her child, or a young person lost in the juvenile justice system, The Foundling provides the resources necessary to strengthen lives and rebuild families.

O We serve over 27,000 children and families each year in all five boroughs of New York City and surrounding counties, and Puerto Rico.

Implementation Support Center (ISC)

O The Foundling formally established the ISC in 2012 with the ultimate goal of increasing the number of children and families receiving proven Evidenced-Based Models (EBMs) throughout New York City.

O Over the last four years the ISC has offered implementation support for six EBMs which were implemented in agencies both in the US and internationally.

O The overarching goal of the ISC is to support and agency and government system in the adherent and sustained implementation of an EBM.

The Implementation Support Center Our Philosophy

The Foundling formally

established the ISC in 2012

with the goal of increasing the

number of children and

families receiving proven

Evidenced-Based Models.

OUR MISION

To support providers in the US

and Internationally by training

government and non-

government agency leaders in

the methodology and practical

implementation of Evidenced

Based Practices.

OUR VISION

Children and families in the child

welfare or juvenile justice system

deserve high quality services which

have been researched and

demonstrate successful outcomes.

Families possess unique strengths

which can be built on to keep their

children at home.

OUR VALUES

How Can Evidenced Based Models Make an Impact?

• Providing evidence-based interventions will:

• Decrease the length of time that children and families are involved

with the formal child protection system

• Provide an opportunity to intervene at the right moment to avoid

repeat maltreatment

• Decrease the number of children entering foster care or another

community placement

• Reduce children’s length of stay in foster care placements if

placement is warranted

• Improve outcomes for children and families

• Save tax payer money!

The Power of Discipline in an EBP Replication

• Evidence-based programs have the scientific research to support a

thoughtful investment and replicating EBPs has just as much of a monastic

rigidity throughout its implementation:

O Model purveyors are hands-on and provide built-in QA processes

O Practitioners are trained by the experts to systematically target risk

factors

O Consistent oversight by model experts track adherence

• Collectively, EBP’s disciplined approach focuses on building families’

natural and ecological supports to reduce dependency on formal systems,

thus furthering the tax-payer’s ROI (Return on Investment)

A way forward with EBPs • Reform within one local system at first – this way we are able

to plan for and address any barriers systematically with the

provider, local governing body, EBP consultant and community

as a team

• A successful implementation will provide us with the best

replication model to ensure smooth dissemination across

multiple territories

• Implementing in the real world, and in real-time can be

challenging, but being able to learn from your international

partners’ experiences can give you a head start

Evidence Continuum Evidence Continuum

Evidence

Continuum Type of Evidence

Confidence

Continuum

Experimentally Proven

(Ready for Scale) Multiple RCT’s Very High

Experimental

Randomized Control Trial (RCT) High

Regression Discontinuity

Interrupted Time Series

Matched Comparison Group

Moderate

Research

Informed

Correlational Study

Pre-Post Outcome Survey

Post-Test Outcome Survey

Low

Opinion

Informed

Satisfaction Survey

Personal Experience

Testimonials

Anecdote

Very Low

Evid

ence

Bas

ed

Created by: Blueprints for Healthy Youth Development in Collaboration with Blueprints Policy Group

Laying the Foundation for the Expansion of

What Works in NYC Legend: JJI – Juvenile Justice Initiative: FAP – Family Assessment Program:

PINS – Persons in Need of Supervision: JD – Juvenile Delinquents

NYC Placement Rates

NYC Placements 2003 2007 2014 2017

Rate of youth in

care ages 0-18

(per 1000)

11.0 8.9 6.5 4.9

# of youth in

placement (total)

21,554 16,911 11,511 9,009

Residential: 871

Foster Boarding Home: 4,314

Kinship: 2,722

NYC Foster Care Placements 2000 to Present

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,0002

00

0

20

01

20

02

20

03

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

17

Foster Care Placements

Foster Care

Placement

The EBP Influence on NYC’s System Shifting focus and funding to preventive services

O Success in diverting Juvenile Justice placements pointed to the possibility for a

similar potential in preventing child welfare

O Upfront investment in placement prevention while scaling down out-of-home

placements necessary

O Preventive programs can mitigate/correct safety and risk while child is at home

O Communities can remain safe while youth remain home with preventive services

Changing how the Child Protective Services define success

O Funding focus shift from outputs (how many activities) to outcomes (how many

stay home)

O Treatment can be short term and intensive and meet the system, community,

family and children needs. Longer length of stay is not linked to better

outcomes, in fact, the opposite

O Short term treatments can increase successful outcomes

O Services delivered at home within the context of the families more sustainable,

effective and affordable

O Focus on performance indicators connected to outcomes define good agency

practice

The EBP Influence on NYC’s System Continued

Limiting opportunities for families to access out of home placement

O Exhausting EB community options before gaining court access or considering out-of-home placements

O Using Treatment Foster Care Oregon as placement prevention

O Increased risk tolerance in courts and child protection for kids to stay home

Service System

O Services as usual teams can convert and deliver EBPs with adherence

O Clinical work can be delivered by Bachelor’s level staff

O Many EBP can be delivered within the current funding structures

O Social Workers will work alternative schedules

O As EBP teams mature they deliver better outcomes

Lessons Learned

Buy-in from agency and stakeholder leadership is critical to the success of an EBP implementation – the individuals with influence and the power to make change

Managing pressure from the funding source(s) while creating a shared understanding between the provider, funder and local authority

Use of real-time data to develop teams/stakeholder relationships across time

Interventions are not substitutes for relationships

Don’t oversell O Realistic expectations about reaching full implementation

benefits

ISC Implementation Support Center

The New York Foundling

ISC and CDT

O The ISC uses the CDT model in working with other agencies and governments to implement EBMs

O A meta-analysis showed that the CDT counties served twice as many youth and completed recommended implementation activities more thoroughly.*

O This analysis also looked at other implementation models to discover over-arching important themes for implementation. It was discovered that overall there is a “core content of implementation” them (Purpose, Process, Key Influences, Stakeholders, and Capacity) and the frameworks all act as a lens through which the process of implementation is structured. In this type of application the framework becomes heuristic in nature. *

O *Bianca Albers, Robyn Mildon, Aaron R. Lyon, Implementation frameworks in child, youth, and family services-Results from a

scoping review, Children and Youth Services Review (2017), doi:10.1016/j.childyouth.2017.07.003

Cal-40 Study

O Focus of NIMH trial Testing an implementation model (CDT) for

promoting installation of an EBP (in this case MTFC)

Random study 51 sites (California and Ohio) randomized

to CDT and implementation as usual Currently the only empirical test of an

implementation model

O We have used the CDT to help child serving systems and agencies overcome common but thorny barriers to successful implementation.

Community Development Team Model (CDT)

O The CDT model is a strategy or approach for

increasing the adoption of evidence based practices

(EBP) in everyday human services

O It is focused on EBP programs, models and

interventions

O It is about implementing (establishing) and

sustaining, with model-adherence (fidelity) or integrity

O Involves a cohort of teams or agencies implementing

together

Common Implementation Challenges

O Selecting a suitable model

O Selecting suitable staff

O Arranging for thorough training

O Managing referrals

O Arranging for practice specific supervision

O Arranging for replacement training

O Monitoring and supporting fidelity

O Tracking program outcomes

O Insuring sustainability

Reviewing and Selecting: Why choose an EBP?

O Fit with target population

O Fit with intended outcome(s)

O Level of demonstrated effectiveness

O Readiness to be implemented and sustained with fidelity Tried and proven training protocols

Tools for monitoring fidelity and outcomes

Replacement training options

Goals of the Community Development Team Model

O Sustainable, model-adherent implementation of an evidenced-based practice

O All CDT activities need to be directed toward this goal O Clarify, plan, coordinate, convene, support, reinforce O Key features

O Clear, rigorous and sustainable training models O Extensive planning and supports O Peer-to-peer assistance O Removal of barriers O Program performance evaluation

Contact for the Implementation Support

Center at the New York Foundling:

Lisa Shankweiler

Lisa.Shankweiler@NYFoundling.org

(212) 660-1386