BBI/Six Core Strategies

Overview

The Building Bridges Initiative© (BBI)-Six Core Strategies© implementation support project began in February 2019. It focused on building organizational capacities to support the use of trauma-focused, youth and family voice-driven strategies within clinical settings. The project was a partnership among the University of North Carolina at Chapel Hill’s School of Social Work, multiple state agency components, national BBI consulting teams, Local Management Entities/Managed Care Organizations (LME/MCOs), provider agencies, and family-centered organizations. Over the next two years, implementation support specialists from Frank Porter Graham (FPG) Child Development Institute worked with a state project team, a state learning collaborative, and multiple Psychiatric Residential Treatment Facility (PRTF) sites to help support their use of BBI best practices and Six Core strategies toward transforming child residential care in North Carolina. The pilot project wrapped up the initial phases of these efforts in 2021. The following sections provide more details on the background of this work.

Learn about the foundation of this project below.

Partnership & System Map

Internal agency stakeholders, community, family/youth, and system partners are actively involved in co-creating implementation capacity to support getting new intervention(s) into real-world practice.  Partners play active roles in listening to identify strengths/barriers, establishing culturally relevant supports and services, detecting practice changes, addressing system barriers, and fostering communication and feedback for improvement. Below is the partnership and system map utilized in the BBI/Six Core Pilot Project:

Partnership System Map. Follow link for full description.

Aligning with other evidence

Organizations, especially within child serving systems, are often tasked with implementing several new innovations all at once. This can include clinical interventions, programs, and policies. During the pilot project, many of the leaders and teams within the youth residential treatment programs expressed concern that BBI and Six Core Strategies would be one more thing added to an already very long list of initiatives underway at their agency. Hence, a key take-away was to support teams in taking stock of all the initiatives that were currently underway to ensure that both BBI and Six Core could be aligned with these initiatives. Here we outline a few strategies and resources to support the alignment of BBI and Six Core with other evidence-based innovations.

  • Pull Source Documents: We recommend that organizations pull innovation specific documents to use for other alignment activities. This could include clinical manuals, fidelity assessments, protocols, training manuals, etc. Sites participating in the BBI/Six Core pilot referenced the BBI Self-Assessment Tool  and the Six Core Strategies 2nd Edition Service Review Tool  as two examples of source documents used.
  • What’s the Vision?: As your team reviews all your initiatives, it’s helpful to have the larger vision and mission of your organization in mind, as well as the purpose of reviewing your initiatives in the first place. For example, one pilot agency engaged in an initiative review for the specific purpose of streamlining the types of data they collected to monitor youth and family outcomes.
  • Merging vs. Aligning: Remember that alignment does not mean merging; the Building Bridges Initiative principles and Six Core Strategies are rather flexible frameworks and tend to align with other trauma-informed programs and practices. However, merging initiatives may unintentionally send the message that you’re blending core components with another program which may affect the fidelity of one or both. Hence, it’s helpful to be clear that you’re looking for alignment among initiatives to reduce redundancies and increase efficiencies in various capacity areas rather than diluting the effectiveness of evidence-based practices.
  • Downsizing may be an Outcome:  As you review your initiatives, your team may realize that you may have initiatives that have contrasting goals, values, or practices that necessitate decisions around de-implementing certain practices rather than aligning them with BBI and the Six Core Strategies. For example, many of the pilot agencies found that frameworks that supported restraint/seclusion practices with youth were in direct contrast to the principles of BBI and Six Core Strategies.

Tools and resources to support Initiative alignment

BBI Program Overview

The Building Bridges Initiative© (BBI) identifies and promotes practice and policy initiatives that create strong and closely coordinated partnerships among families, youth, community and residential service providers, advocates, intermediaries, and policy makers. BBI supports an experience-based, practice and evidence-informed set of trauma-informed principles that when effectively incorporated, have been shown to lead to improved clinical and organization outcomes driven by centering youth and family voice in all aspects of clinical and case management interventions.

Learn more about BBI

Six Core Strategies Overview

Six Core Strategies© bring specific intervention and programming solutions to reducing restraints, seclusion and otherwise perceived punitive/coercive milieu activities. Six Core Strategies© also endeavors to build agency wide prevention cultures so that the use of restraints/seclusion and other coercive strategies is redirected into strengths-based, trauma-informed approaches that motivate and heal youth.

Learn more about Six Core Strategies©

How Implementation Fits

During the pilot, our team provided implementation support to seven pilot youth psychiatric residential treatment facilities across North Carolina. Our goal was to support each agency in developing the organizational capacities needed to install, support, and ultimately sustain the practices and principles of BBI and the Six Core Strategies.

This was an important aim of the project, as the traditional model for youth mental health agencies is to receive initial training in a new practice without the tools and abilities in place to successfully implement and sustain that practice to achieve desired outcomes. Without an intentional focus on the ’how,’ it’s very easy to return to business as usual in the day-to-day business and complexities of the mental health system. This is where the field of implementation science and practice fits to help address this challenge that many complex systems face. Effective implementation best practices allow for people and organizations to build local capacity and performance through the use of leadership and teams, getting and using data, workforce professional development, and usable interventions that fit the context and needs of the agency. Furthermore, it centers co-creation partnerships through all stages of the implementation process to foster meaningful stakeholder engagement.

During the BBI/Six Core pilot each agency was paired with two implementation support specialists who met with their team on a regular basis through virtual meetings and on-site visits. Our implementation support included ongoing assessment of implementation capacities and the development of support activities, tools, and resources that could be adapted to each agency’s unique context. A major piece of our work was supporting each agency to define the principles of BBI and Six Core in a way that fit with their agency and their current clinical activities. Despite the challenges of the Covid-19 pandemic, we met with the sites over 200 times to focus on the implementation of these frameworks.

The agencies that participated shared that implementation support was helpful to their success in implementing both BBI and Six Core Strategies in the following ways :

  • “Implementation support can provide an intimate environment to learn about implementation science practices and strategies in real time as you implement the strategies in real time.”
  • “Ongoing feedback is helpful and having space to discuss it felt helpful, not like a lecture.”
  • “Implementation support has been solid. Individual and group consultation and training efforts have been worth the time and energy invested.”
  • “Truly, you [implementation support team] have been the best part. It’s been the perfect balance of theory, practical strategies, and support (technical and emotional).”
  • “One of our biggest lessons learned was to prioritize focus on implementation every week, even in the midst of crisis. There will always be short term crisis to react to, but proactive, ongoing focus on implementation wins.”
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