Child Welfare Id e n ti fyi n g a n d Im p le m e n ti n g Evi d - - PowerPoint PPT Presentation

Id e n ti fyi n g a n d Im p le m e n ti n g Evi d e n c e B a s e d ( a n d P r o m i s i n g ) P r a c ti c e s

Child Welfare

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Overview

Defining Evidence Based and

Promising Practice (EBP) in Social Work and Child Welfare

*Selecting and implementing EBP

within Social Work and Child Welfare

Examples of EBP in Child Welfare Discussion

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Evidence Based Practice

 Medicine: The integration of best research

evidence with clinical expertise and patient

• values. (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000)

 Human Services: A systemic process that

blends current best evidence, client preferences (wherever possible), and clinical expertise, resulting in services that are both individualized and empirically sound. (Shlonsky & Gibbs,

2006)

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The Social/ Child Welfare Worker’s Role as an Evidence Based Practitioner

 Placing the client’s benefits first, evidence based

practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching

• bjectively and efficiently for the current best

evidence relative to each question, and taking appropriate action guided by the evidence. (Gibbs, 2003),

 EBP is an expansive process, requiring careful

reasoning on the part of the practitioner. (Mullen & Streiner, 2006 )

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Evidence Based Practice Model

Clinical state and circumstances Research Evidence Clinical Expertise Client Preferences and Actions Agency/ Partner Concerns

(Regehr, Barber, Trocme, Hart & Knoke, 2005)

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Implementing EBP within Child Welfare

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Challenges to Selecting and Im plem enting EBP in Child Welfare

 Numerous stakeholders and clients, multiple

gatherers of information, and multiple sources of information

 The scope of needs, services, and practice spans a

multitude of service areas and treatment modalities

(Roberts, Yeager, Regehr, 2006)

 Lack of integration of evidence based practice within

and across disciplines (Roberts, Yeager, Regehr, 2006 )

 Implementers have responsibilities across numerous

tasks (Roberts, Yeager, Regehr, 2006 )

 Circumstances/ Contexts often pose limitations

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Steps to Im plem enting EBP in Hum an Services

 Conduct a thorough, well-executed assessment,

identification of problems, and identification of desired outcomes

 Identify potential empirically supported treatments  *Select the best fitting intervention in view of the

client problems (and strengths), situation, and desired outcome

 Supplement and modify the treatment as needed,

drawing on practitioner knowledge

 Monitor and evaluate intervention effectiveness

(Proctor & Rosen, 2006)

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Steps to Implementing EBP in Child Welfare Organizations/ Administrations: EPIS

 Exploration, Preparation, Implementation, and

Sustainment (EPIS) framework to guide program selection and implementation (Aarons, Hurlburt, & Horwitz, 2011)

 Similar to Proctor and Rosen’s Steps for Implementing EBP in

Human Services (2006)

 Developed by the Child and Adolescent Services Research

Center (CASRC) through funding from the National Institute

• f Mental Health (NIMH)

 California Evidence Based Clearinghouse (CEBC) framework  Selecting and Implementing Evidence Based Practices: A Guide

for Child and Family Serving Systems (Walsh, Rolls, Reutz, & Williams, 2015)



http:/ / www.cebc4cw.org/ files/ ImplementationGuide-Apr2015-onlineprint.pdf

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Treatm ent Selection: Individuals

 Assess: Systematically gather accurate and valid

information (about the child and family) that is relevant to the EBTP process

 Integrate: Combine the information gathered by the

community professionals involved (with a family) into a coherent and agreed upon case formulation

 S-N-P: Construct a matrix of Strengths, Needs, and Problems

(for the child and family)

 Goals: Establish measureable treatment and intervention

goals with specific metrics for determining successful

• utcomes

 Match the treatment to the problems and goals…

(Saunders, 2013)

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Treatm ent Selection: Key Considerations

 Key components of preferred “proven” programs

and your client needs/ program context

 *Breadth of treatment impact

 Programs with the highest level of evidence may not be best fit

 Time, effort, resources required for treatment  What engages and motivates

 Achieve quick success in early components  Limit multiple interventions/ Do “one” good thing  Incorporate solutions to barriers/ revise

(Saunders, 2013; Roberts & Yeager, 2006)

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Levels of Evidence

 Various ways to describe “Levels of Evidence” (Rosenthal, 2006

• n page 71)

(1)

Systematic reviews or meta analysis of multiple, well- designed controlled, experimental studies (and guidelines based on meta-analysis)

(2) Well-designed individual experimental studies (randomized,

controlled)

(3) Well-designed quasi experimental studies (nonrandomized,

controlled)

(4) Well-designed non-experimental studies (nonrandomized,

uncontrolled)

(5) Case series and clinical examples, expert committee reports

with critical appraisal (and guidelines based on best practice)

(6) Opinions of respected authorities based on clinical

experience

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Treatm ent Selection: Resources/ EBP Databases

 NREPP: SAMHSAs National Registry of Evidenced

Based Programs and Practices

 http:/ / www.nrepp.samhsa.gov/ AdvancedSearch.aspx

 The What Works Clearinghouses

 http:/ / www.acf.hhs.gov/ programs/ opre/ research-and-evaluation-

clearinghouses

 *The California Evidenced Based Clearinghouse for Child

Welfare

 http:/ / www.cebc4cw.org

 Even more: The Social Work Policy Institute

 http:/ / www.socialworkpolicy.org/ research/ evidence-based-practice-

2.html#resources

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Treatm ent Selection: Other Resources

 Guidelines

 Child Welfare League of America (CWLA) Standards of Excellence  http:/ / www.cwla.org/ our-work/ cwla-standards-of-excellence/ standards-of-

excellence-for-child-welfare-services/

 Child Welfare Information Gateway  www.childwelfare.gov  The National Institute on Drug Abuse (NIDA)  http:/ / www.drugabuse.gov/ publications

 Systematic critical reviews of intervention studies

 The Community Preventive Services Task Force  http:/ / www.thecommunityguide.org/  The Cochrane Collaborative  http:/ / www.cochranelibrary.com/  The Campbell Collaborative  http:/ / www.campbellcollaboration.org/ lib/

 Journal articles  Evaluation Reports

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Child Welfare Evidence Based Treatment/ Program Examples

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The Science of Assessm ent and EBP

 EBP assumes proper assessment and problem identification  A number of assessments for understanding problems and

specific populations have strong validity, reliability, sensitivity, and specificity (CEBC)

 Child and Adolescent Functional Assessment Scale (CAFAS)  Ages and Stages Questionnaire 3 and Social Emotional (A)  Keys to Interactive Parenting Scale (KIPS) (A)  http:/ / www.cebc4cw.org/ assessment-tools/

 Although several examples of best practices in assessments,

there are few tested “Comprehensive Family Assessments”

 North Carolina Family Assessment Scale (NCFAS) (A)  Family Assessment Form (FAF) (B)  Federal CFA Project/ Illinois Integrated Assessment RCT (promising

practices)

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Traum a Treatm ent

 Relatively well-developed array of EBP to treat Trauma  Benjamin E. Saunders, Ph.D., Presentation: So Much

Trauma, So Many Interventions: How Do We Choose?

 http:/ / www.cebc4cw.org/ online-training-resources/ webinars/ so-

much-trauma-so-many-interventions-how-do-we-choose/

 EBP Trauma Interventions:

 Level 3: Cognitive Behavioral Interventions for Trauma in Schools

(CBITS); Child and Family Traumatic Stress Intervention (CFTSI); Alternatives for Families – Cognitive Behavioral Therapy (AF-CBT)

 Level 2: Child Parent Psychotherapy (CPP)  *Level 1: [Parent Child Interaction Therapy (PCIT)]; Eye-Movement

Desensitization and Reprocessing (EMDR); *Trauma Focused Cognitive Behavioral Therapy (TF-CBT)

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Traum a Focused Cognitive Behavioral Therapy (TF-CBT)

 Treatment method appropriate for children and adolescents

impacted by trauma and their parents or caregivers

 The therapist works with the child on managing the effect of the trauma,

and the parent or caregiver learns how to better support the child.

 Child shares a narrative about the trauma with his or her caregiver.

 Evaluation:

 Proven to successfully resolve a broad array of emotional and behavioral

difficulties associated with single, multiple and complex trauma experiences.

 10+ randomized controlled trials supporting its efficacy  Current: MDRC is evaluating implementation of TF-CBT at Children’s

Institute, Inc. (Partner in National Traumatic Child Stress Network)

 More Information/ Training/ Locating Providers:

 Official TF-CBT National Therapist Certification Program (where clinicians

can become certified in the treatment model)

 https:/ / tfcbt.org/

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Transition to Adulthood/ Non-m inor Dependency

 Research studies defined the problem and indicate

youths who stay in care until age 21 fare better

 Fostering Connections Act = example of evidence based

policy development

 Few proven programs, but emerging consensus about

EBP (Practices) for youth aging out of care

 Offer comprehensive array of services or connection to these services

(education, health, mental health, employment/ training, financial literacy and asset building)

 Provide individual case-management/ mentoring  Provide housing supports/ housing

 New promising evaluation results and planning for more

evaluation

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Supportive Independent Living Program s

 Youth Villages Transitional Living Program (MDRC)

 YVLifeSet = intensive, individualized, and clinically focused case

management, support, and services to young adults with histories of foster care or juvenile justice custody

 Significant increases in housing stability and economic well-being

and health and safety in comparison to the control group

 Equally effective across different subgroups of youth  No significant improvement in education, social support, or

criminal involvement.

(Jackobs Valentine, Skemer, Courtney, 2015)

 Evaluations in process

 Building Capacity to Evaluate Interventions for Youth/ Young Adults

with Child Welfare Involvement at Risk of Homelessness (Mathematica)

 California Youth Transitions to Adulthood Study (Mark Courtney) JCDS Consulting

Education of Foster Children: Prom ising Practices

 Little to no rigorous evaluation of educational practices

demonstrating effectiveness with youth in care

 Children in foster care are some of most vulnerable in the

education system:

 High rates of repeating a grade by third grade  High rates of school mobility  Overrepresented in educational achievement gaps

 Best available evidence comes from evaluations of programs

implemented with other populations (Dworsky, Smithgall, Courtney, 2014)

 What Works Clearinghouse

http:/ / ies.ed.gov/ ncee/ wwc/ aboutus.aspx

 Guidelines and Practices within Child Welfare: Legal Center

for Foster Care and Education: American Bar Association

 http:/ / www.fostercareandeducation.org/ Home.aspx

()

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Encouraging Use of Evidence Based Practice in Child Welfare

 Practitioners/ providers of services:

 Use clinical assessment tools and processes  Engage in the EBP implementation process

 Organization/ Program Leadership:

 Support through policies, procedures, and incentives  Procedures to support fidelity  Access to technical assistance

 Researchers, evaluators and intermediaries

 Understand user needs  Build research into implementation.

 Local, State, and Federal leaders

 Manage/ minimize the effects of competing/ conflicting policies  Maximize opportunities for success by working across systems. JCDS Consulting

• 1. W h a t i s y o u r e x p e r i e n c e w i t h e v i d e n c e b a s e d

p r o g r a m m i n g i n c h i l d w e l f a r e a n d h o w d o e s t h e c o n t e n t d i s c u s s e d h e r e r e s o n a t e ?

2 . W h a t c h a r a c t e r i s t i c s o f E B p r a c t i c e h a v e y o u

u s e d i n y o u r c h i l d w e l f a r e w o r k ?

3 . W h a t m e t h o d s o f E B p r a c t i c e h a v e y o u f o u n d

c h a l l e n g i n g t o i m p l e m e n t w i t h i n c h i l d w e l f a r e ? W h y ?

4 . H o w d o e s y o u r o r g a n i z a t i o n f o s t e r e v i d e n c e

b a s e d p r a c t i c e ? W h a t a r e t h e c o n s t r a i n t s ?

Discussion

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References

Aarons G.A., Hurlburt M., Horwitz S.M. (2011) Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Mental Health. 38(1): 4-23. doi: 10.1007/ s10488-010-0327-7. Dworsky, Amy, Cheryl Smithgall, and Mark E. Courtney. 2014. “Supporting Youth Transitioning out of Foster Care, Issue Brief 1: Education Programs.” OPRE Report # 2014-66. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide w ith integrated m ultim edia. Paific Grove, CA: Brooks/ Cole-Thom pson Learning. Jacobs Valentine, E., Skemer, M., Courtney, M. 2015. “Becoming Adults: One-Year Impact Findings from the Youth Villages Transitional Living Evaluation.” MDRC. New York, N.Y. Mullen, E. J. & Streiner, D. L, (2006). The evidence for and against evidence based practice. Albert R. Roberts & Kenneth R. Yeager, editors. Foundations of evidence-based social work practice. New York, N.Y.: Oxford University Press. Proctor, E. K. and Rosen, A. 2006. “Concise standards for developing evidence-based practice guidelines.” In Foundations

• f evidence-based social w ork practice Edited by: Roberts, A. R. and Yeager, K. R. 93–102. New York, NY: Oxford

University Press. Regehr, C. Barber, J. Trocmé, N. Hart, S. Knoke, D. (2005) An Evidence-Based Model for Risk Assessment in Child Welfare, SSHRC Research Cluster Grants, Concept Paper. University of Toronto: Centre for Applied Social Research. Roberts, A.R., Yeager. K. & Regehr, C. (2006). Bridging evidence-based health care and social work: How to search for, develop, and use evidence-based studies. In A.R.,Roberts & K. Yeager (Eds.), Foundations of evidence-based social work practice (pp. 3-20). New York, N.Y.: Oxford University Press. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based m edicine: How to practice and teach EBM (2 ed.). New York: Churchill Livingstone. Saunders, B.E. (2013, May). So much trauma, so many interventions: How do we choose? Webinar presentation sponsored by the Chadwick Center for Children and Families and the California Evidence-Based Clearinghouse for Child Welfare, May 16, 2013, San Diego, CA. Shlonsky, A., & Gibbs, L. (2004). Will the real evidence-based practice please stand up? Teaching the process of evidenced- based practice to helping professions. Brief Treatment and Crisis Intervention, 4(2), 137-153.