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Innovation based on research and practice wisdom takes time

by PeakCare Qld on 25th February 2015

Home -> Articles -> 2015 -> February -> Innovation based on research and practice wisdom takes time

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Engaging with research to deliver exemplary services to children, young people, parents and the community takes time. The DMERTTS framework being rolled out at Mercy Community Services is an example of a desired and clearly articulated program that has taken time to develop due to considering its design and intent – positive outcomes for children and families. This is an organisational implementation capacity building framework. It also guides the design, monitoring and evaluation of services and programs. Such designs cannot be rushed and need to be considered within the plethora of complexities and multitude of considerations within which it they operate.

DMERTTS is an acronym for the: Documentation, Monitoring and Evaluation, Reporting, Training, Teamwork, and Supervision (DMERTTS) Framework. Its designer, Dr Stewart Redshaw acknowledges: “It really is quite a mouthful, but each component has a critical part to play in helping to develop, implement, evaluate and report on the programs we deliver to vulnerable children, young people, their families and adults in the community”.

The knowledge that underpins program design and DMERTTS implementation includes: practice literature, empirical research, implementation science, needs theory, standards, legislation, quality frameworks, evaluation theory and frameworks, funding and service agreements, program design theory and logic models, information technology and knowledge management.

Dr Redshaw, takes us behind the scenes of his DMERTTS framework in explaining its intent and the reality that whilst the framework has been finalised, the implementation is only in the early stages. Whilst some programs are quite advanced in terms of how the programs and client administration service delivery and client outcome are noted and data collected, other programs are in the infancy stages.

The DMERTTS framework is designed to both enhance Mercy Community Services’ readiness and capacity for implementing an organisational service quality framework with a view to becoming an outcomes-focused organisation, as well as providing a detailed template for developing tailor made evaluation - DMERTTS framework for each program.

DMERTTS is structured around six core categories of program documentation, monitoring and evaluation strategies, reporting, and supporting areas of staff training, teamwork, and supervision. It consists of 44 documentation, measurement and evaluation activities chosen to help guide and enhance services and to assist quality administrative, output, impact and outcome data.

The framework has two key purposes:

1. It is an Organisational Implementation Capacity Building Framework – specifically structured to help MCS lay the ground work for delivering and evaluating quality services.

2. It provides a guide for designing, monitoring and evaluating the individual programs Mercy Community Services’ Family Services (MCS-FS) provide. This includes 25 distinct programs across MCS-FS in the following program areas: counselling and intensive family support services, foster and kinship care programs, residential and therapeutic residential care services, and multicultural placement and support services. All of which will need a tailor-made framework to guide program evaluation activities.

In noting the meaning of the individual words making up the acronym DMERTTS, the overall focus of this approach is self-explanatory:

Documentation - is about ensuring that what we do is based on the best available practice and research literature, and critically, that we have documented our practice in a Model of Practice using both clinical and logic design features.

Monitoring & Evaluation – is about using rigorous evaluation processes to collect, collate and analyse a range of administrative, output, impact & outcome data.

Reporting – is reporting on the results to the department, and the wider practice research and practice community through conference presentations, publications, and practice exchanges.

Training, Teamwork, & Supervision – ensuring that we have the best possible staff to provide the services, that they are well trained, work in high-functioning teams, and have excellent supervision.

Whilst such a comprehensive framework and the roll out of the DMERTTS framework could have been seen as too ambitious, Dr Redshaw acknowledges the challenges faced: “One of the main challenges over the years has been finding the dedicated time within day-to-day life of work at MCS and all the competing priorities to focus on developing and refining the framework. This leads us to face the ever present perennial question faced by human services management – ‘What is priority and what can we do now’?”

In answering that question Dr Redshaw remembers the bursting notion and personal challenge to get everything done straight away. This is a major issue for community services but most working in this arena soon realise that prioritisation is essential. As such the roll out has had to focus on key areas and assume a manageable pace. Therefore the first implementation wave is focused on gathering and reporting on the following measures: Client Profile, Service Provision, Service Usage, Client Impact and Outcome - including client status, client wellbeing/functioning, client condition, client benefit, and client satisfaction.

Dr Redshaw reflects how the DMERTTS framework has been progressively developed and refined over 10 years or more: “The motivation to get the framework off the ground has been our desire to deliver the best quality services we can, particularly (in the early days) for the very vulnerable children and young people we were looking after in residential and foster care, and progressively extending to their families and the community in general through a range of family support and intensive intervention programs. We’ve always had a strong commitment to excellence and quality, and this has been reflected in our Models of Practice and service outcomes over many years and we are continually referring to the research and practice literature to check what we currently do against what is emerging as best practice and reviewing our programs accordingly.

The round of Royal Commissions, Senate Inquiries and Judicial and Departmental investigations into the child protection and out-of-home care sectors in Queensland specifically, and across Australia have also been driving factors. Dr Redshaw emphasises that: “These significant inquiries have driven numerous reform processes over the last decade or so, each in its turn increasing the imperative to improve the services we provide to improve the outcomes for children and young people (and families) we support.”

In summarising the factors that have worked well, Dr Redshaw notes the following:

  • Human success factors are critical. Working with clinical staff in a collegial and supportive manner to develop practice frameworks and assessment/evaluation processes is critical.
  • The support of the organisation’s management in developing and implementing DMERTTS related activities is very important.
  • Ensuring that staff are not overloaded with onerous DMERTTS reporting requirements. One of our main principles is that measures and strategies adopted need to be relevant and meet the needs of clinicians and practitioners in their day-to-day work.

In terms of the next steps of the DMERTTS roll out, they will include the writing of biennial and/or triennial program reports in alignment with funding cycles. Then findings from the various reports (as well as the results of research projects) will be presented across a range of conferences and practice exchanges to increase work published in research and practice journals.

The final major step is full integration of all DMERTTS activities with MCS’ Client Management System (CMS). Redshaw proclaims: “This is my ultimate goal that all the measures and evaluation strategies adopted for each program will as far as possible be computerised. So that staff and clinicians will be able to see client level, or program level case profiles at a click of a button, that managers and research staff will also be able to access data about how individuals, programs/services, and the organisation as a whole is going in a timely and accessible fashion. The development of Mercy Community Services’ Client Management System is well underway and the plan is to progressively integrate DMERTTS activities and CMS reporting functions over the next several years”.

In striving for excellence organisations grapple with the ‘how to’ in terms of quality interventions with children, young people and their families who face multiple complex issues and are at times reticent to engage. Dr Redshaw has provided a solution he believes works well in ensuring excellence in program delivery to clients whilst also supporting staff across the organisation in fulfilling their respective roles. He asserts that laying a foundation of quality evidence based practice will assist both practitioners and clients. Any program that can successfully lay claim to this will be welcomed in Queensland. Such programs should also be noted nationally and internationally.