The Norwegian Labour and Welfare Directorate

1. The Norwegian Labour and Welfare Directorate TheHPMT project Model, methods and programCore components Implementation and fidelityTerje Lillehaug, Program Manager

2. What is HPMT? (HPMA in English) • The HPMT (HPMA) model • The Holistic model - a model for comprehensive client follow-up ofunemployed individuals living on welfare support, and with complexsocial problems (clients recruited on a set of predefined criteria) • Principle-driven - 10 principles that contribute to the quality and direction of the work • A methodical approach based on systematized knowledge (and evidence), and practical, practice relevant methodological tools • The HPMT (HPMA) program: • Target group – primary intervention level: Client supervisors (the social workers) in local welfare offices • Teaching and training (9 (3+2+2+2) + 2 days (four sessions in 4 – 6 months), and systematic supervision every one week / fourtnight • HPMT project - Two plans – one project • Teaching and training (see above) • Research and evaluation

3. The project framework and design • Duration 2010 – 2013 • Core intervention and implementation • In 9 welfare offices with a total of apr. 40 service providers/social workers. Teaching and training sessions in 2011 – Full implementation with supervision and ”fidelity follow-up” every week/or fortnightly on office level during 2012. • The research • RCT / cluster design: 18 welfare offices randomly selected in 9 intervention offices and 9 control offices (business as usual) • Process evaluation – multi methodical • Culture-Anthropological – Post-doc project – Focus on “Action competence”

4. Implementation and fidelity maintainaceMultilevel activities and responsibility • Level 1: Primary intervention levelService Providers (Client supervisors/social workers) in welfare offices on Municipality level)Get: Teaching, training and supervisionGive: Client supervision, support and follow-up, multi-systemic process management, case progress analyzes and management • Level 2: Senior service providers (client supervisors/social workers) in welfare offices on Municipality levelGet: Teaching, training and supervisionGive: Supervision and support to level 1. General problem-solving analyses interventions on welfare-office level. Process documentation

5. Implementation and fidelity maintainaceMultilevel activities and responsibility • Level 3: Coordinators / Supervisors – County levelGet: Teaching, training and supervisionGive: Supervision and support to level 2. Readiness mainteinance, and interventions on welfare-office level • Level 4: Resource group / Supervisors – Directorate level Give: Teaching and training. Supervision and support to level 3. Readiness maintenance, and interventions on all levels on a request and “need to be done basis

6. Project purpose and objective • Improved - more effective services (measurable) • Improvement and strengthening of the service providers / social-workers methodical competence (C = knowledge, skills, attitude and values) • Test the effect and relevance of the HPMT model, program and methodical tools on both service and client level • Generate scientific evidence on which future methodical recommendations can be based

7. Results – Output on client level (to be tested in the effect evaluation) • Increased numbers of clients in positive activity • Increased numbers of clients employed • Strengthening of client inclusion (and social capital) • Improved life-skills and quality of life • Reduced drug abuse • Improved, mental health • Improved client satisfaction (service delivery) The work and research hypothesis is that HPMT can have a measurable effect on these variables given that the methodology is implemented fully and with good quality.Correlation will be tested at both program and method / implementation fidelity level

8. Basic questions in teaching, training and presentation of HPMT and during work process: • What do we do? • Why do we do it? • How do we do it?

9. The HPMT implementation process Manual based, planned and systematic6 stages og implementation: (Fixsen et. al 2005) • Exploration and Adoption • Program Installation • Initial Implementation • Full Operation • Innovation • Sustainability Documented and verifiable Organizational readiness required

10. Readiness Dean L. Fixsen (2009) defines “readiness” as follows: “Readiness” is defined as a developmental point at which a person, organization, or system has the capacity and willingness to engage in a particular activity. Creating readiness for change is a critical component of both initiating and scaling up the use of evidence-based practices and other innovations in education.”

11. Implementation – core activities Initial implementation Securing management support and responsibility Teaching and training Organizing and practical problem solving Full operation (but still not full scale due to project limitations) Maintenance of management support Integration and use of methodical tools Supervision and documentation Practical and organizational problem solving and interventions

12. HPMT – Core activities • Innovation and evaluation - A continuous development process where core components are fixed, with room for adjustments and improvements • Maintenance and sustainability – lasting change - Maintenance of management support - Implementation of achieved experience from what works and what improves methodical fidelity (org. and provider level) and results (on client level). - HPMT ”Booster-seminars” at least twice a year.

13. The Holistic/comprehensive client follow-up model Three intervention areas with three sets of selected methodical tools Workflow: Client request and referral Collecting initialclient information Initial client need analyses and service leveldefinitionExtended need analyses Planning Implementation Evaluation • Individual supervisor/client interaction • Professional comuni- cation, / client dialog (MI) • Defining problems, client resources,needs, and possibilities • Identify networkresources • Agree on activitiesand responsibilities • Client oriented follow-up interventions • Multi-systemic interaction and intervention • Securing client as the key actor in system interaction • Process management to Involve and mobilize: • - Relevant professionals - Private network and family • - Employers and colleagues • Case manage- ment and documentation • Securing client as the key actor • Quality control of documentation legal rights etc. • Progress analyses • Intervention planning (multi-level/multi-task)

14. 10 methodical principles in HPMT Focus on achievements and resources Gather information about network resources Draw unambiguous conclusions and agreements Be reliable and predictable Secure availability, continuity and flexibility Be prepared Acknowledge clients definitionof problems and situation Clarify roles and expectations Give sufficient and relevant information Stay focused on goals/objectives and actions leading to change Behind each of the methodical principles are one or more methodical tools, that makes the social worker act in accordance with the principles. The principles to help supervisors to remember the methodological tool and works as a cognitive check-list

15. Methodical tools and theoretical perspectives • Tools • Communication based om ”Motivational Interview” (MI) • Motivation and change interventions using both MI and tools from cognitive psychology • System interventions and process-management based on ”AppreciativeInquiry” (AI) and process-structuring tools like ”The 5D-model” and a 4 point process check-list • Manuals and templates for planning, documentation, analyses and interventions • Theoretical perspectives based on: • Pragmatism – what do we think is the possible and appropriate action - what’s in it for me? • Social and symbolic Interactionism – It’s all about how and about what we interact