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

Child Welfare 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 JCDS Consulting

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 JCDS Consulting

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) JCDS Consulting

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 objectively 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 ) JCDS Consulting

Evidence Based Practice Model Clinical state and circumstances Client Research Preferences Clinical Expertise Evidence and Actions Agency/ Partner Concerns (Regehr, Barber, Trocme, Hart & Knoke, 2005) JCDS Consulting

Implementing EBP within Child Welfare JCDS Consulting

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 JCDS Consulting

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) JCDS Consulting

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 of 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  JCDS Consulting

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 outcomes  Match the treatment to the problems and goals… (Saunders, 2013) JCDS Consulting

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) JCDS Consulting

Levels of Evidence  Various ways to describe “Levels of Evidence” (Rosenthal, 2006 on page 71) Systematic reviews or meta analysis of multiple, well- (1) 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 JCDS Consulting

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 JCDS Consulting

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 JCDS Consulting

Child Welfare Evidence Based Treatment/ Program Examples JCDS Consulting

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) JCDS Consulting

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) JCDS Consulting

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/ JCDS Consulting