Ontario’s Special Needs Strategy:
Integrated Delivery of Rehabilitation
Services
Spotlight Series Webinar on Change Management
July 29, 2016
Toll-Free: 1-855-340-1607 Conference ID: 3134031#
Webinar Link:
https://opsevents.webex.com/opsevents/onstage/g.php?MTID=ee0bddf2c58f4a3704
970a13f82d3271e
1
2
Overview
1. Describe the approach used to change practice using
Partnering for Change as an example
2. To support a discussion amongst members of the local
Steering Committees/Proposal Development Tables
about their experiences in managing change through
their local processes
2
The Change Process
5
Exploration
Installation
Initial Implementation
Full Implementation
Sustained Implementation
Ghate, Deborah. (2015). From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families, Journal of Clinical Child & Adolescent Psychology, 00:1-15. Retrieved April 1, 2016 from http://dx.doi.org/10.1080/15374416.2015.1077449
Two to four years from exploration to full implementation
D E B R A S T E W A R T , M S C . O T R E G . ( O N T . )
S C I E N T I S T , C A N C H I L D C E N T R E F O R
C H I L D H O O D D I S A B I L I T Y R E S E A R C H ,
M C M A S T E R U N I V E R S I T Y , H A M I L T O N , O N
LESSONS LEARNED ABOUT
CHANGE MANAGEMENT AND TRANSFORMATION OF
SCHOOL-BASED REHABILITATION SERVICES
PARTNERING FOR CHANGE PROJECTS
• “Partnering for Change” is a model that was first
developed by CanChild researchers, leaders from
the Central West CCAC, and many other
stakeholders to address the inequity and escalating
needs of children with Developmental Coordination
Disorder (DCD)
• Pilot project 2008-09
• Demonstration project 2009-11
• Knowledge translation project 2011-12
• Implementation and Evaluation project 2013-15
SPECIAL NEEDS STRATEGY: INTEGRATED REHABILITATION SERVICES
• Implementation of a new service model for children
with special needs in Ontario – an integrated
approach involving three professions
• Transformation from traditional preschool and
school health services to a tiered model of
capacity-building in children’s natural contexts –
requires significant change at all levels
Provides a framework to get started and throughout an implementation Guides you to identify factors and strategies to consider, and their interactions
IMPLEMENTATION SCIENCE
FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)
Start with the Environment
• The ‘traditional’ model of
service delivery will create
barriers at first for
implementation of a tiered
model
• Preparing the stakeholders
and the organizational structures will greatly
enhance the implementation
of the new intervention
THE INTERVENTION:
A TIERED MODEL FOR IRS
• Essential for some
• E.g., one-on-one intervention
Tier 3
Individualized
Services
•Necessary for many
•E.g., small group intervention, parent/caregiver training, parent consultation
Tier 2
Targeted Services
•Beneficial for all •No formal intake/assessment
•E.g., collaborative consultation, early years setting/classroom/school strategies
Tier 1
Universal Services
12
FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)
Stakeholder perceptions,
characteristics and actions
• a range of reactions and
actions
• include all stakeholders in
implementation activities
and decisions
• educate/inform everyone
• be prepared to manage
conflict
FACTORS INFLUENCING IMPLEMENTATION (AND STRATEGIES TO ADDRESS THEM)
Organizational Structures
• current structures and systems
need to be changed:
- billing and data collection systems
- organization of therapists’ time in
schools, and payment
- ‘caseload’ vs. ‘workload’ measurement
• allow time for therapists to start
implementing the tiered
approach in schools before
‘releasing’ wait lists
“IT’S A HUGE TRANSFORMATION”
•Multiple systems, services and people are involved in this change
• Be prepared for complexity
• Transformation takes time
Planned change management
is needed
CHANGE/TRANSFORMATION TO IRS • Kotter’s 8-step change model
Create urgency
Guiding ‘Coalition’
Develop a Vision
Communicate Vision
• Change driver: Special Needs Strategy: IRS
• Use current evidence to support the need for change locally
• Engage diverse
leaders in the steering group
• Establish a ‘working group’ with stakeholder representation
• Develop strong relationships and partnerships locally
• Program Guidelines articulate a vision
• What do we want to see change to make a positive difference for
children with special needs and families
• Create a strategy to communicate and execute vision
• Frequent, clear,
concise, honest, 2-way communication
• Tackle anxieties openly
• Empower others by engaging them in
conversation as you begin (preparation phase) and throughout implementation
• Agencies
• Therapists
• Educators
• Community
• Parents
CHANGE/TRANSFORMATION TO IRS
• Kotter’s 8-step change model
Remove Obstacles
Short Term Wins
Build on Gains
Institute Change
• Training up front
• Assess and revise organizational structures and
procedures to fit with the new approach
• Use the Vision!
• Recognize staff and programs for their contributions - provide incentives for implementing a tiered approach
• Share strategies
that work
• Regular ‘Update’
sessions with all stakeholders
• Ongoing mentorship for sustainability
• Program evaluation
after year one – what have we learned so far?
• Set indicators and outcomes based on experience and learning – involve all stakeholders in setting these up
• Continue to develop training and mentorship resources
“TRANSFORMATION TAKES TIME”
• Establish a ‘change management’ plan
• Preparation is needed before implementation • Use Implementation Science framework to identify factors and
strategies
• Get the environment ready
• Bring all stakeholders together
• Start education and training of everyone early
• BUILD RELATIONSHIPS!!!
• A ‘transition’ period of implementation from the ‘old’ approach to the ‘new’ approach is important • Learn from experience and from each other
• Collaborative problem solving
BIBLIOGRAPHY
American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association (2014). Workload approach: A paradigm shift for positive impact on student outcomes. Retrieved July 16, 2016 from www.asha.org/uploadedFiles/ASHA/Practice_Portal/Professional_Issues/Caseload_and_Workload/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-Schools.pdf Barr, J. & Dowding, L. (2016). Leadership in health care. Third Ed. Thousand Oaks, CA: Sage Publications Ltd. Camden, C., Swaine, Tetrault, S., & Carriere, M. (2011). Going beyond the identification of change facilitators to effectively implement a new model of services: Lessons learned from a case example in paediatric rehabilitation. Developmental Neurorehabilitation, 14, 247 – 260.
Camden et al., 2016 (in preparation). A framework for study implementation of an intervention. Kotter International (2016). The 8-step process to leading change. Retrieved July 26,2016 from http://www.kotterinternational.com/the-8-step-process-for-leading-change/ Missiuna, C., Hecimovich, C., Dix, L., Campbell, W., Pollock, N., Bennett, S., Camden, C., Decola, C., McCauley, D Gaines, R., Cairney, J., & Stewart D. (2015). Partnering for Change: Implementation and Evaluation, 2013 – 2015. Final Report for the Ontario Ministry of Health and Long Term Care and the Ontario Ministry of Education. Hamilton, ON: CanChild, McMaster University. Available at www.partneringforchange.ca
RESOURCES
Campbell, W., Selkirk, E., & Gaines, R. (2016). Speech-language pathologists’ role in inclusive education: A survey of clinicians’ perceptions of universal design for learning. Canadian Journal of Speech-Language Pathology and Audiology, 40(2), 121-132.
CAST. (2011). Universal design for learning guidelines version 2.0. Wakefield, MA: Author.
Causton, J., & Tracy-Bronson, C.P. (2014). The speech-language pathologist’s handbook for inclusive school practices. Baltimore, Maryland, USA: Paul H. Brookes Publishing Co.
Causton, J., & Tracy-Bronson, C.P. (2014). The occupational therapist’s handbook for inclusive school practices. Baltimore, Maryland, USA: Paul H. Brookes Publishing Co.
Giangreco, M.F. (2002). Absurdities & realities of special education: The best of ants…,flying…,and logs. Minnetonka, MN, USA: Peytral Publications, Inc.
Hanft, B. & Shepherd, J. (Eds) (2008). Collaborating for student success. A guide for school- based occupational therapy. Bethesda, MD: American Occupational Therapy Association.
Labrie Blackwell, A., & Dunn, W. (2016). Active ingredients for an embedded intervention within the early childhood classroom. Journal of Occupational Therapy, Schools, & Early Intervention, 9(2), 125-141.
Laverdure, P. (2014). Considerations for the development of expert practice in school-based occupational therapy. Journal of Occupational Therapy, Schools, & Early Intervention, 7, 225-234.
Lidz, C.S., & Pena, E.D. (2009). Response to intervention and dynamic assessment: Do we just appear to be speaking the same language? Seminars in Speech and Language, 30(2), 123-133.
Morse, A. (2015, August 10). Glossary of special education terms. Retrieved from http://education.easterseals.org/glossary-of-special-education-terms/
R.A. Malatest & Associates Ltd. (2014). Review of integrated full day kindergarten children’s treatment centre pilots: Definitional report. Ontario Ministry of Children and Youth Services. Toronto, ON, Canada.
Roberts, G. (2015). Communities of practice: Exploring enablers and barriers with school health clinicians. Canadian Journal of Occupational Therapy, 82(5), 294-306
WEB-BASED RESOURCES
CAST is a non-profit education research and development organization that works to expand learning opportunities for all individuals through Universal Design for Learning. http://www.cast.org/
CONNECT Professional Development Modules from the Center to Mobilize Early Childhood Knowledge. http://community.fpg.unc.edu/
Frank Porter Graham Child Development Institute. Generates knowledge, informs policies and supports practices to promote positive developmental and educational outcomes for children from all backgrounds and abilities from the earliest years. http://fpg.unc.edu/
Ontario Centre of Excellence for Child and Youth Mental Health. They have a series of short modules including: leading organizational change and teamwork and collaboration, www.excellenceforchildandyouth.ca/resource-hub/learning-modules
Professional learning resources for Alberta educators developed by Alberta Education http://www.engagingalllearners.ca/
Schoolwide Integrated Framework for Transformation (SWIFT). Swift is a K-8 technical assistance center that builds school capacity to provide academic and behavioural support to improve outcomes for students through equity-based inclusion. http://www.swiftschools.org/
SNOW is the branch of the Inclusive Design Research Centre at OCAD University that focuses on inclusive education and learning. Their goal is to provide information and training for educators, parents and students with disabilities on technologies for learning both in and out of the classroom as well as promote understanding of inclusive practices. Resources are free whenever possible and SNOW focuses on providing open source tools that can be adapted and used freely. http://www.snow.idrc.ocad.ca/
UDL Supporting diversity in BC Schools. The content of the site was developed from a variety of print and online resources and is intended to provide K-12 educators with a starting point for implementing Universal Design for Learning in their classrooms. http://www.udlresource.ca/