Developed by Scott Miller PhD, psychologist and co-founder of the International Center for Clinical Excellence and the Institute for the Study of Therapeutic Change, The Outcome Rating Scale (ORS) and Session Rating Scale (SRS) are brief measures for tracking client functioning and the quality of the therapeutic alliance. Each instrument takes less than a minute for clients to complete and for clinicians to score and interpret. Versions of the scales are available for adults, children, adolescents in 18 different languages.
Kids First: Creating an evidence-informed, client-centred service
About the organisation
Formerly the Children’s Protection Society, Kids First has provided a wide range of services to vulnerable children and families since 1896. Kids First supports children and families underpinned by guiding principle of ‘HEART’ – Hope, Empowerment, Accountability, Respect and Trust.
We spoke with
Director, Client Services
Head of Practice, Client Services
at a glance
Consistent with its commitment toEvidence-informed practice
, Kids First has launched a new service model and is currently trialling twoEvidence-based programs (EBPs)
– Caring Dads, and Children and Mothers in Mind – in addition to completing a Randomised Controlled Trial of its Early Years Education Centre. Kids First launched its new service model in September 2018.
The new service model is informed by the principles ofProgressive universalism
, which involves a tiered continuum of service delivery, with progressively more intensive levels of support for children and families depending on risk and need. The model is delivered through an all-of-family lens and focuses on outcomes-based service delivery rather than outputs.
Kids First identified the need to provide a more flexible, integrated and coordinated service response for their children and families.
Consistent with government reforms, the organisation also recognised it needed to become more outcomes-focused and applyEvidence-informed practice
to the organisational structure as a whole, with multidisciplinary teams that could provide more complex wraparound supports for clients.
“We wanted to make sure that there is a clear service pathway for a client to take while remembering that kids are at the heart of everything we do.”
- Integrating design elements — Creating an organisation-level theory of change and Practice Framework has helped create holistic rather than piecemeal change.
- Embedding and integrating evaluation processes — Adopting International Centre of Clinical Excellence Feedback Informed Practice using Outcomes Rating Scale and Sessions Rating Scales to more systematically evaluate outcomes with clients.
- Impact of systemic changes — Things do not always go to plan, especially when there are multiple competing priorities. The timing of the rollout of the model was affected by the timing of other reforms, such as the simultaneous rollout of the Orange Door which Kids First was supporting.
- Taking time to reform and genuine involvement of staff — The reform process was time consuming, taking over nine months to design, refine and start implementing the new model. The experience has highlighted the importance of trying things out and actively seeking feedback. Taking this time ensured the organisation and staff were happy with the approach and allowed enough time to foster the culture of change needed for implementation.
While Kids First undertook a systematic approach to the design and implementation of the new service model, their journey to better outcomes was by no means linear.
Embarking on an organisational restructure
Knowing that this level of change would be difficult to achieve alone, an external consultant was engaged early in the journey to undertake consultation with internal leadership and community stakeholders. As a result, Kids First developed a community-centred and outcomes-focused operational framework relevant to the local context.
Kids First Organisational Architecture
Early and genuine engagement of staff
Kids First included staff in design and decision making processes from the outset. Staff were asked to define what ‘evidence informed’ meant to them. This feedback was used as a starting point to determine how they perceived the purpose and impact of their work.
Creating a theory of change (TOC) and a model of service
Kids First created an organisation-levelTheory of change
to help to guide decision-making and make sure that the identified activities would lead to the intended outcomes. The TOC then steered the team toward their new model of service. Drawing on the best available research,Practice expertise
Kids First developed a model of service underpinned by the following practice principles:
- Evidence informed
- Child centred and family inclusive
- Trauma informed
- Culturally responsive
- Person centred.
The new model offers a centralised clinical intake service to support two multi-disciplinary centres ensuring that children and their families are directed to the appropriate support aligned to their needs and goals.
Implementing the model of service: a new practice approach
With the TOC and new model of service in place, Kids First developed their new practice approach. The model recognises that not all clients are seeking long-term assistance. Two multi-disciplinary centres provide targetedIntervention
, integrated care planning for children and their families and tailored responses usingEvidence-informed practice
Notably, Kids First now provide all families with a Brief Family Consultation (BFC) therapy session at the start of the service. BFC is a time-limited, structured process which uses clinical expertise in goal setting to manage client expectations and set them up for success.
Kids First now use Scott Miller’s Outcomes Rating Scale and Session Rating Scale to embed evaluation into practice. Both scales are evidence-based tools for measuring, strengthening and building the client-practitioner alliance.
Staff are trained in the use of these tools, which have been pivotal in enabling practitioners to be more responsive to client needs. Since launching the model, Kids First is using the data collected with these tools to reflect and continually shape practice.
Incorporating staff feedback to strengthen implementation
Formalising and incorporating staff feedback into the design and implementation of the new model has been a significant part of the journey. The senior leadership team held regular feedback sessions with staff to discuss potential obstacles and to address them collaboratively. While this might have meant some discomfort, when hearing that the program was not always unfolding as planned, it also meant staff were more receptive and enthusiastic about the change, even in the face of challenges.
An external consultant also conducted regular consultations with staff, exploring how they were experiencing the changes and whether they needed additional supports including training and professional development.
“We need to give staff an opportunity to practice and continually revise these skills, rather than completing the training and walking away, supervision and having opportunities to keep practicing is critical.”
While the new model has not been operating long, one of the key successes so far is seeing that practitioners are more confident with their use of micro skills in practice.
When staff initially indicated this was a skill that needed further development, Kids First responded by embedding training and follow-up support into their program and have seen major improvements as a result.
For Kids First, the next stage in their journey to better outcomes is to fully implement the processes governing clinical supervision and review into practice to ensure service delivery is client centred and systematic.
Kids First is committed to embedding a culture of evidence-informed decision making within the organisation. The next stage is to develop a new client service database to support data collection, review and applying lessons learnt when trialling and selecting new services for their clients and in further strategic planning.