identifying factors and solutions to make service-wide improvements

This section is different from the other resources sections. It presents a tool that can be used to enhance practices across a whole service or organisation. The other resources are designed for individual practitioners to use to fine tune their work and they provide a helpful focus for reflection.

Anyone wishing to see more examples of innovative practices or ways of organising services can read about them in the Handbook.

Helping as a system  |  Using the system tool

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This section is best worked on by a group who can influence how relevant aspects of work are organised and conducted. 

When there are sticking points, or concerns that outcomes are not as good as they could be, it is important to recognise what is causing these problems, in order to develop effective solutions.

This is best done in a group, where different insights can be offered, including from people who are in a position to drive relevant changes forward. These changes may involve new policies, procedures, hard or soft rules, ways of arranging practice etc.

All services involved in the study are invested in optimising what they do. We take outcomes for family as the ultimate and most important focus for assessing and improving practices. These pages offer a tool that helps to diagnose the causes that constrain outcomes. It also helps to identify what solutions might look like.

The key point is that getting the most out of partnership needs more than excellent work by amazing people. Sometimes, change at a system level is also needed. This tool helps to accomplish this  efficiently by identifying and resolving a practice tension – something that inhibits optimal outcomes.

 

helping as a system of activity

The tool involves mapping different aspects of a particular service as an activity system [1]. The components of the system are shown in the following diagram.

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us

Parents, professionals, volunteers

Change

What we are trying to achieve together

Tools

Things and ideas we can use

Rules

Funding, protocols etc

Community

Everyone involved

Roles

Who does what


Every service can be mapped in this way, but what each component looks like will vary each time it is mapped


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us

‘Us' will sometimes involve a nurse, parent and child; other times, a fluid team spanning different professions working with the extended family.

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change

Change can have multiple aspects to it. Some will be short-term, others long-term; some will relate to parents, others to children (see the spirals inliving partnership practices).

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tools

Tools can be ideas that come from specialist expertise, like the Circle of Security [2], or PRIDE skills used in Parent-Child Interaction Therapy [3]. The Family Partnership Model, and the ideas presented in this website can be used as a tools to aid work that aims to bring about change.

Many services use written protocols to structure admissions and record information. The Edinburgh Postnatal Depression Scale. Ages and Stages Questionnaire, Eyberg Child Behaviour Inventory, and NCAST Parent Child Interaction coding scales are all examples of such tools.

Tools can also be objects such as t-shirts used as sleep associations, towels to support tummy time, or bad-day plans stuck to a fridge door (we saw these used in home visiting and day stay services, where the bad day plan was created by parents).

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rules

Rules can be formal like those that set levels of funding or require mandatory reporting. They can also be informal or even unwritten – more like accepted ways of working.

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community

Community can mean the local community. This was particularly relevant in the playgroups and parenting groups we studied, and in Tasmania’s Child and Family Centres. In other services the community may not be directly involved, but helpers may enable parents to access support or foster connections within their community.

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roles

Roles means who does what. The essential ingredients section describes different ways of being in partnership, showing how parent and helper roles need to be fluid if progress is to be made. 'Roles' also refers to responsibilities of different members of the family, friends and community in relation to the children in question.

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using the activity system tool

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The diagram above adds numbers along lines linking one component of the system and another. This tool is all about the relationships between the components, rather than the components by themselves. 

To use this as a tool to enhance practices, follow these five steps:

  1. Think of something that constrains outcomes in some way – this is the practice tension that needs resolving
  2. Look at the system diagram and decide which two components this practice tension involves
  3. Diagnose what is causing the tension: the relationship between these components is not optimal
  4. Consider which of the two components needs to be changed (or both)
  5. Identify what needs to happen to make that change in one or more components. This is your solution.

The next part of this page provides examples of practice tensions between different components. All the examples come from real cases we studied.


It is important to remember that the tensions do not mean that different people are in disagreement or conflict. These are practice tensions, meaning they are tensions that arise in the course of efforts to resolve complex problems. They are to be expected in any complex practice. When understood in the way this tool suggests, they can become an engine of positive change across a system.


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Us | Tools

Practice tension between those working together, and the ideas or things they use in doing so

 

One parent commented that objects on the walls didn’t fully celebrate cultural diversity and the whole family (not many pictures of dads and grandparents!).

Several practitioners mentioned that it isn’t easy to benefit from the knowledge and experience of others. A system to curate and share practice wisdom would resolve this.

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Tools | Change

Practice tension between the ideas / things being used, and the problem being worked on

 

We found evidence that the impacts of many services were far wider, deeper, and lasting than were captured in the current system. Data based on usage or delivery, parents’ changing confidence are important, but insufficient. Some of the tools in this website might help to document impacts more fully.

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Tools | Community

Practice tension between the ideas / things being used, and wider group of people involved

 

The example of the bad-day plan (see below) shows how the community can be a source of effective tools. This pathway appears to be under-used in many contexts. Pathways for embedding ideas from the research community in practice need further work (this website aims to address this, at least partially!).

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Us | Rules

Practice tension between the people working together and the rules they have to follow

 

Deciding which families get help from particular services and when was a recurring tension. Some services have duration or age-based limits that risk parents falling off a support cliff at the end. When the condition of one young child was regarded as too complex for a mental health service, this was a tension between ‘Us’ and the Rules. In these instances, new rules are needed to stop children falling through cracks in the system.

We found innovative and successful solutions to problems relating to waiting times, as with services that offer help while parents wait (the Handbook has examples of such practices).

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Us | community

Practice tension between the people working on a problem and the wider group who are involved in some way

 

There may be many families experiencing significant challenges who don’t become ‘US’ (i.e. partners with helpers). They may not know what help is available, or may be scared to seek it out. Tasmania’s Child and Family Centres are pioneering outreach work through door knocking, pop-up playgroups and other initiatives.

“We’d run a pop-up playgroup in the park to get new families in.” (Helper)

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Rules | Change

Practice tension between the rules that people have to follow and the problem they are working on

 

Some practitioners reported that protocols and procedures made the work more task focused. They felt a more people-focused approach would be more effective. Where rules were rigid or strictly imposed, they were barriers to frontier work (see living partnership practices). Funding insecurities compromise outcomes. Sometimes, services risked becoming victims of their own success; as group sizes grew, quality interactions between helpers and families were harder to maintain.

Some tensions do require changes at a high level to ensure rules don’t get in the way of outcomes.

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Us | Roles

Practice tension between the people working together and the roles and responsibilities they have

 

Many services operated without the benefit of a fluid network of knowledge about families, other than what is shared in case notes.

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Change | Roles

Practice tension between the problem being worked on and the different roles / responsibilities people have

 

As communities’ and families’ needs change, the numbers and kinds of staff required may not be met. Delays replacing staff may have significant negative effects that outlive vacant positions. Security for staff and agility in staffing are clearly crucial.

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Change | Community

Practice tension between the problem being worked on, and the wider group of people involved

 

Accessing community supports can be hard for some families, and helpers often play a crucial role in brokering this for parents. Communities can be a strong driving force for wider change. One Child and Family Centre (Tasmania) in particular was working with the Neighbourhood Centre and primary school to achieve things that wouldn’t otherwise have been possible.

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Using the activity system tool to enhance practice

There is no specific worksheet for this section, as it is designed to prompt practice change at a broader level rather than individual reflection.

Anyone wishing to use this tool should go through the steps described above.

Back to using the tool overview Back to top  |  Back to resources overview  |  Claim your certificate


References

[1] This comes from a branch of educational research called cultural-historical activity theory, see Engeström, Y. (2001). Expansive learning at work: toward an activity theoretical reconceptualisation. Journal of Education and Work, 14(1), 133–156. doi:10.1080/13639080020028747

[2] Powell, B., Cooper, G., Ho man, K., & Marvin, R. S. (2016). The Circle of Security intervention: enhancing attachment in early parent-child relationships. London: The Guildford Press. 

[3] Praise, Reflection, Imitation, Description, Enjoyment – see Hembree-Kigin, T. L., & McNeil, C. B. (1995). Parent-Child Interaction Therapy. New York: Plenum Press. Or see this guide for clinicians.