Transcript Evidence Based Practice - Muskie School of Public Service

Use of Evidence Based Programs
Department of Social and Health Services
Engaging,
Motivating,
Assessing, and
Working Successfully
..... with Children and Families
Dana Phelps, M.Ed.
Evidence-based is defined in
Washington as:
Models that have..strong
science/research support
Models that have.. been
replicated (done) in several places
Best practice?
Best practice is a term that usually refers to common or acceptable
practice.
For example accreditation standards
Best practices usually have shown some outcomes, but may not have
undergone a “study and control group” design study
Best practices will always have a place in practice because:
Not everything will be researched
There is no program that meets every child’s needs
Not every child welfare activity can be measured
Do we have to study a program before we
use it?
Not necessarily. There are some child welfare areas
where little or no research has been done
Promising practices may be implemented and studied as
they are being used
It makes sense to use evidence based programs when
they already exist for a group of children. When an EBP
does not exist, then a promising program may be used
Programs in Washington
Multidimensional Treatment Foster Care (MTFC)
Functional Family Therapy (FFT)
Parent Child Interaction Therapy (PCIT)
Promoting First Relationships
Incredible Years Program
Nurse Family Partnership
Homebuilders
Parent Child Interaction Therapy
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treatment for parents and young children (ages 2-7)
emphasizes improving the parent-child relationship and
changing parent-child interaction patterns
In PCIT, parents are taught specific skills to establish
a nurturing and secure relationship with their child and
methods of appropriate discipline. PCIT is provided to
a parent and child pair over approximately 20 weeks.
Parents are required to practice the new skills at home
with their child.
Parent Child Interaction Therapy
PRIDE Skills
Praise appropriate behavior. -
Use labeled praises.
Reflect appropriate talk -
This is the skill that gets kids to
talk!
Imitate appropriate play -
Depending on your child, you
may imitate exactly or with
similarity
Describe appropriate behavior. - States what the child is doing
right.
Enthusiasm
Homebuilders
An Intensive Family Preservation Services program designed
to prevent out of home placement of children.
Utilized when a family has been referred for child abuse and
neglect and the child or children are at imminent risk of
placement.
Program is short in duration, usually 4 to 6 weeks. (40 hours
of service average in those 4 – 6 weeks)
Homebuilders therapists respond to families 24 hours a day,
7 days a week.
Homebuilders
The program focuses on teaching parents to care effectively
for their children by increasing the parents ability to:
• manage child behavior
• utilize appropriate discipline,
• provide a safe and nurturing home environment
Therapists have a low caseload (two cases at a time)
Functional Family Therapy
• Research-based prevention and intervention program for
adolescents and their families
• Targets youth between 11-18….
• Short-term, family-based program
• Average of 12 sessions over 4 months
• Range of adolescent problems
• drug abuse/use, conduct disorder, family conflict
FFT Family-based philosophy...
• We know families can be….
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discouraged
hopeless
emotional
blaming
less than motivated
• Our job…meet them where they are…
• We understand all families are uniquely organized
– each a different and complicated social systems
• We know all families have strengths and resources
that we can tap
• Family is the “client”
Guiding Principles
Obtainable but lasting change
The outcome goals of therapy are those that are
obtainable and lasting
– not someone’s idea of healthy families but……..
– obtainable behavioral changes
...are those that are:
• obtainable behavioral changes …
• for these people …
• with these resources …
• and these value systems …
• in this context
FFT shows several important outcomes when used in
child welfare settings:
– a reduction in negativity within the family
– improved communication in the family
– increased parental supervision
– reduced placement in foster care (FPS)
11% foster placement in FFT vs. 49% foster placement in services as usual
Trauma Focused CBT
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treatment for children (ages 5 -18)
emphasizes skills to cope with past trauma
TF – CBT teaches children in an individual setting
ways of coping with past traumatic experiences and
new skills. Caregivers of the children participate in
some sessions where they learn to support the child.
This treatment is appropriate for children with
“internalizing” behaviors and is not appropriate for
children who are “acting out.”
Trauma Focused CBT Components
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Psycho-education
Emotion regulation skills
Correcting maladaptive cognitions
Desensitization/trauma narrative
Interpersonal skills
Positive parent management
CBT Triangle
Thoughts
Behavior
Feelings
Emotion Regulation Skills
“Helping children manage negative emotions”
Targets: fear, anxiety, depression, anger
Strategies:
– Feelings identification
– Relaxation
– Controlled breathing
– Cognitive coping
– SIT
– Take a break
– Mindfulness
Incredible Years Program
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treatment for parents of young children (ages 2-7)
emphasizes improving the parenting skills and use of
appropriate discipline
Incredible Years teaches groups of parents specific
skills to use in parenting their child and methods of
appropriate discipline. The Incredible Years program
groups will last between 12 and 16 weeks.
Parents are given homework to practice at home with
their child.
Multidimensional Treatment Foster Care
Program that serves children in a specially
trained foster home
Only one foster child per home
Foster home is supported by a case manager
that is available 24/7
Foster parents create a behavior management
plan with the case manager
Multidimensional Treatment Foster Care
The foster parents provide consistent rewards for
positive behavior
Privileges are gained by the child for following the
program
Foster child’s time heavily structured
Multidimensional Treatment Foster Care
Child is awarded points for following rules and
directions
Child loses points for “problem” behavior
Child usually has an individual therapist
Child’s “family” has a family therapist
Multidimensional Treatment Foster Care
Outcomes
MTFC shows three important outcomes for
the child welfare population:
• fewer placement disruptions
• a decrease in rate of problem behavior
• a 90% retention rate of foster families
Multisystemic Therapy (MST)
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treatment for families with adolescents
teach parents skills and connect them to
resources needed to independently address the
difficulties of raising teenagers
A focus is placed on helping youth and families cope with family, peer,
school, and neighborhood problems. Within a context of support and skill
building, the therapist places developmentally appropriate demands on
the adolescent and family for responsible behavior. Intervention
strategies are integrated into a social ecological context and include
strategic family therapy, structural family therapy, behavioral parent
training, and cognitive behavior therapies.
Multisystemic Therapy (MST)
The program is designed as an alternative to placing children out
of home.
The therapist carries a caseload between 5 and 7 families and is
available to the family 24/7.
The interventions primary goal is to reduce the need for out of
home placement. It has successfully reduced the number of
days in psychiatric hospitalization by 72% as compared to a
treatment as usual program.
An MST adaptation for treatment of families of younger children
is currently being studied for application in child welfare cases.
Programs being looked at:
Family Integrated Transitions (FIT)
Outcomes for co-occurring mental health and
substance abuse
Project Safe Care
Home visiting program that focuses on parent and
child bonding and infant/child health care
What about when there is no research?
At times, best practices are the only thing available to
guide practice
When developing a new practice, evidence based
programs can provide a foundation for building a program
or practice (i.e. skills that are effective with a group of
people)
We can work with model developers and experts in the
field to build the new practice or program
What are the limits?
No one program has yet been found to solve all the
problems faced by children
There is not enough research on minority
populations to know that every program works with
every population
Successful use of evidence based programs
depends on having skilled providers and support
from the community
Where to get more information
The Washington State Institute for Public Policy
recently published a report.
http://www.wsipp.wa.gov/pub.asp?docid=08-07-3901
Other state’s are doing similar work. Information on
California’s efforts can be found at:
http://www.cachildwelfareclearinghouse.org
Questions
For more information contact:
Dana Phelps
(360) 902-7653