Transcript Integrating Evidence-Based Practices into CBCAP Programs

PROTECTIVE FACTORS: HOW THEY
SUPPORT OUR DAILY WORK IN
COMMUNITIES AND FAMILIES
Edi Winkle, MSW
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Desired Outcomes
Understand the research behind protective factors and the
definitions of existing protective factors and frameworks
Understand the crosswalk of protective factors to direct
services and how they correlate
Understand Family Centered Practice Principles and their
interaction with Protective Factors
Understand the role the Protective Factors Survey plays in
understanding impact on families*
Examine current plans/services and how they interact with
Protective Factors*
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Laying the Groundwork
FRIENDS is funded through a
cooperative agreement with
Children’s Bureau and OCAN
Strengthen
critical
partnerships
and networks
Supporting EI
and EB
practices
OCAN
emphasizes 4
key areas to
promote wellbeing in
families
Broader
definition of
well-being
Promote
protective
factors as key
strategies
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For example,
A characteristic or
situation that reduces
or buffers the effects
of risk, and promotes
resilience in the face
of risk. It is an asset
of some kind.
A skill,
personal
attribute, or
supportive
relationship
Or a
community
that offers
supportive
services and
opportunities.
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ACYF FRAMEWORK
What is a Protective Factor?
Children who have experienced
maltreatment, trauma, and/or exposure
to violence are a highly vulnerable
population, however
• Resources and policies can be leveraged to improve
child functioning
• Effective practices and programs are available
• Outcomes for children can significantly improve
with an emphasis on social and emotional wellbeing
Research has shown that the
promotion of protective factors
is a key intervention strategy
that can improve social and
emotional well-being in children
and youth.
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2013 RESOURCE GUIDEBOOK
Why Protective Factors
Research on protective factors is relatively new compared
to the research literature assessing risk factors for children
and youth.
At the same time, in many fields there has been an
increased emphasis on understanding protective factors.
In general, protective factors can occur as individual attributes of
children or youth, or as adult caregiver characteristics and skills,
yet …
protective aspects of families, peers, schools, and communities
directly influence the absence, presence, and impact of individual
protective traits—all operate together as a system.
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ACYF DRAFT FRAMEWORK
Research and Protective Factors
Our Focus in Protective Factors
Conditions, when present in our families and communities, increase
the health and well-being of children and families.
Nurturing and Attachment
Knowledge of Parenting and Child
Development
Parental Resilience
Social Connections
Concrete Supports for Parents
Social and Emotional Competence
of Children
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Children that feel loved and supported by their parents tend to be more
competent, happy and healthy as they progress into adulthood.
Program Strategies that work here:
Parent education
that shares
information on how a
strong parent-child
bond enhances brain
development and
supports positive
behavior later on
Share resources in
the community on
how parents can
nurture and connect
with their child at
every age
Emphasize the
importance of
connectedness with
all important adults
for the child
Recognize warning
signs and ensure
effective referrals for
parents struggling in
this area
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2013 RESOURCE GUIDEBOOK
Nurturing and Attachment
Parents that understand child developmental stages are more likely to be consistent
with rules and expectations and to communicate effectively with their children
Program Strategies that work here:
Offer informal
interactions with staff
and coaching on specific
challenges (e.g.
inconsolable crying,
biting, eating
challenges)
Offer opportunities for
parent education to be
responsive to issues
presented by parents in
the moment
Give parents the
opportunity to network
with each other
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2013 RESOURCE GUIDEBOOK
Parenting & Child Development
Resilience is the ability to effectively manage all types of
challenges that come up in life.
Program Strategies that work here:
Make mental health
support an integral
service that is seen
as normal, not
stigmatizing.
Provide resources
to parents around
causes of stress and
how it may affect
health,
relationships and
family.
Coach parents in
concrete skills such
as planning, goal
setting, problemsolving, and selfcare
Partner with other
community
resources to help fill
gaps in services for
families
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2013 RESOURCE GUIDEBOOK
Parental Resilience
Being connected - to family, community, friends – has shown
to reduce risk of harm to children
Program Strategies that work here:
Set aside a
welcoming space for
parents to socialize
Offer opportunities
for parents to get
together in
“normalizing”
situations (e.g.
picnics, potlucks,
block parties)
Connect parents with
other organizations
that offer
opportunities for
parents to connect
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Social Connections
Families that can offer the basics – food, clothing, shelterhave more time to devote to other areas of well-being.
Program Strategies that work here:
Connect parents with
economic resources
such as job training
and placement
referrals
Provide referrals for
immediate crisis
needs in food,
clothing and shelter
Recognize challenges
in this area and
provide support
(language barriers,
domestic violence,
mental health,
substance abuse)
Train staff to be
responsive and nonjudgmental in all
areas, including
concrete supports
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2013 RESOURCE GUIDEBOOK
Concrete Supports for Parents
Children that have the ability to self-regulate their behavior and interact positively
with their environment have an increased likelihood of success into adulthood
Program Strategies that work here:
Offer resources for
young people that help
to educate about
effective interactions
and positive
communication skills
Provide an environment
that allows children to
safely express their
feelings and address
conflict with their
parents
Provide parents with
knowledge about norms
in this area and support
to work through
challenges
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Social and Emotional Competence
National Picture on Protective Factors
Early work focused on early
childhood, very young
children
As research body has grown,
a need to expand and
explore has been highlighted
Current efforts by ACYF, CDC
and CSSP are expanding the
list of protective factors
CDC
CSSP
Division of Violence Prevention work in
safe, stable and nurturing relationships (SSNRs)
and the new Essentials for Childhood Initiative
Strengthening Families Initiative to
build protective factors in early
childhood centers
• Defined as an essential for childhood
• buffer against effects of child maltreatment
• fundamental to healthy brain development
Recent work in their Youth Thrive
Initiative to expand the knowledge
base of protective factors for youth
http://www.cdc.gov/violenceprevention/childmaltreatment/index.html
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Youth Thrive
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“Top 10”
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ACCESS AT HTTP://WWW.DSGONLINE.COM/ACYF
ACYF Framework General Model
ACYF Framework CAN Model
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ACYF Research across at-risk populations
spanning service provision levels
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Populations
3 Service
Levels
• Runaway/Homeless Youth
• Youth Exposed to Domestic Violence
• Youth in or Transitioning Out of Foster Care
• Victims of Child Abuse and Neglect
• Pregnant and Parenting Teens
• Individual Level
• Characteristics and skills
• Developmental tasks
• Relationship Level
• Community Level
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PROMOTING PROTECTIVE FACTORS FOR IN-RISK FAMILIES AND YOUTH: A BRIEF FOR
RESEARCHERS
Understanding PF across Populations
SHIFTING GEARS (AND TAKING A BREAK )
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EBP &EIP
Shared Components:
Logic Model
Manual/Protocol
Not Harmful
Accepted Practice
Commitment to CQI &Ongoing Evaluation
EvidenceInformed
Emerging
•Ongoing
collection of
pre/post Data
•Peer Review
Supported
Promising
•All elements of •All elements of
emerging, plus: promising, plus:
•1 study, quasiexperimental
design with
control or
comparison
group
•Document all
implementation
activities
•model fidelity
Evidence Informed
•2 randomized
trials or 2 between
group studies (or
comparable
methodology)
Well
Supported
•All elements
of supported,
plus:
•Multiple site
replication
•one year
sustained effect
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Evidence-Based
Systems Level or Community Level Change requires a comprehensive
approach that creates incentives, capacity, and environment for change.
Professional
Development
Parent
Partnerships
Policy and
systems
Support and Sustain Protective
Factors across the community
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2013 RESOURCE GUIDEBOOK, STRENGTHENING FAMILIES
Levers for Change
Supports prevention strategies that meet
families where they need them
• responsive and relevant
• models relationships across individual, family and
community levels
• provides a positive environment for child development
• engages parents as leaders across all levels
How this might look:
• Work with parents to identify shared goals for the
community
• Create and maintain leadership roles for parents in the
collaboration
• Ensure parents are present at the table when policy and
programming changes are being discussed
• Designate resources to support and train parents
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Parent Partnerships
Integrate protective factors into training for persons in
the community that work with children and families
Schools
How this might look:
Churches
Hospitals
Libraries
Social service
organizations
Mental Health
Community Centers
Provide training at
conferences,
workshops, inservice events
around the
community that
offers the
protective factors
as a guide in their
daily work
Develop a Protective
Factors 101 for use
by any organization
in the community to
understand the
collaborative and its
goals to strengthen
well-being for all
Integrate family
strengthening
themes into
promotional
materials and other
collaborative related
items to get the
word out
Others?
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2013 RESOURCE GUIDEBOOK
Professional Development
How this
might look:
2) strengthens
the work for
the
collaborative
in individual
organizations
• Align and adapt contracts, RFPs, and other mechanisms
to support protective factors where ever possible
• Revise job descriptions, performance reviews,
assessment forms and other mechanisms to promote
protective factor language
• Use protective factors to define a shared set of desired
outcomes for families in the community
• Actively engage multi-disciplinary partners in the
collaborative
Utilizing protective
factors across
systems provides 1) a
basis for a common
language and goals
and
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2013 RESOURCE GUIDEBOOK
Policies and Systems
Levers
Community and
multi-system
leaders act to build
sustainable
infrastructure
through key levers
for change:
• Parent Partnerships
• Policy/Systems
• Professional
Development
Strategies
Community
programs and
workers practice
consistently:
• Facilitate friendships
and mutual support
• Strengthen parenting
• Respond to family
crises
• Link families to services
and opportunities
• Value and support
parents
• Further children’s
social and emotional
development
• Observe and respond
to early warning signs
of abuse and neglect
Protective
Factors
Results
Families and
communities build
protective factors
that also promote
positive outcomes:
• Strengthened families
• Parental Resilience
• Social Connections
• Knowledge of
parenting and child
development
• Concrete supports in
times of need
• Social and emotional
competence of children
• Nurturing and
attachment
• Optimal child
development
• Reduced child abuse
and neglect
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STRENGTHENING FAMILIES
Lining It All Up
Working with the family unit to ensure safety and
well-being of all family members
Strengthening the capacity of families to function
effectively
Engaging, empowering and partnering with
families throughout the decision- and goalmaking processes
Providing individualized, culturally responsive,
flexible, and relevant services for each family
Linking families with collaborative,
comprehensive, culturally relevant, communitybased networks of supports and services
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CHILD WELFARE INFORMATION GATEWAY
Keys of Family-Centered Practice
Reduce
stress
Enhance
parent-child
relationships
Reduce
Social
Isolation
Increase the number of resources parents have to deal with
everyday challenges and crises
• Connect families to needed services (not just those offered with a program)
• Work with family on problem-solving and creating a plan to address stressful
situations such as medical issues, unemployment relationships issues
• Provide opportunities for parents to build their networks of friendship and mutual
support
Offer parents and children opportunities to focus on relationships
and how they impact aspects of daily life
• Offer families opportunities to interact with other families and understand family
dynamics and relationships
• Parent education sessions include children in select sessions and provide modeling
and coaching
• Education settings include parents as team members of IEP or other groups to have a
group, concerted approach to address concerns or issues
Encourage family interaction in programs /community and help
reduce that “I am alone” feeling.
• Offer families casual opportunities to interact with other families to build bonds and
expand their network
• Offer sessions for parents based on types of issues (bed wetting, tantrums, special
needs) to help form bonds with parents that have like issues for support
• Providing opportunities for staff to bond with families and provide support and
encouragement
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STRENGTHENING FAMILIES INITIATIVE
How DO FCP work to reduce CAN?
Levers of Change
Parent
Partnerships
Policy/Systems
Family Centered Principles
Working with the family unit to ensure safety and wellbeing of all family members
Strengthening the capacity of families to function
effectively
Engaging, empowering and partnering with families
throughout the decision- and goal-making processes
Providing individualized, culturally responsive, flexible,
and relevant services for each family
Professional
Development
Linking families with collaborative, comprehensive,
culturally relevant, community-based networks of
supports and services
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LUNCH
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The Protective Factors Survey
Building Protective Factors—
How do we measure it?
PFS Background
Developed to address the shifting focus of prevention
work and federal requests for evidence of effectiveness.
Developed through a partnership with FRIENDS and The
University of Kansas.
Involved multiple experts in the field, parent leaders,
prevention workers, and hundreds of families.
PFS Phases of Testing
Phase
1
Defining constructs, developing item
pool, review by field of experts, pilot
testing resulting in removal of items.
Phase
2
Testing of additional items, factor
analyses, reliability and validity.
Phase
3
Examine stability over time (repeated
administration), expand on validity
testing.
Examine ability to measure change over
time, examine use as retrospective pretest.
Phase
4
PFS Testing
Administered to over 1500 consumers
Administered by approximately 35 agencies.
Administered in approximately 15 states.
Validation using 8 potentially-related
measures.
Child abuse and neglect, coping, depression, stress, physical and
emotional health, optimism, positive and negative emotion.
CSSP Protective Factors
PFS Protective Factors
Parental Resilience
Family Functioning/Resiliency
Social Connections
Social Emotional Support
Knowledge of Parenting
Knowledge of Parenting/Child
Development
Concrete Support in Time of
Need
Concrete Support
Social/Emotional Competence
of Children
Nurturing and Attachment
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Operationalized Definitions
(5 items)
• Having adaptive skills and strategies to persevere
in times of crisis. Family’s ability to openly share
positive and negative experiences and mobilize to
accept, solve, and manage problems.
Social Emotional
Support (3 items)
• Perceived informal support (from family, friends,
and neighbors) that helps provide for emotional
needs.
Concrete Support
• Perceived access to tangible goods and services to
help families cope with stress, particularly in times
of crisis or intensified need.
Family Functioning
and Resiliency
(3 items)
Child Development
and Knowledge of
Parenting (5 items)
Nurturing and
Attachment (4 items)
• Understanding and utilizing effective child
management techniques and having ageappropriate expectations for children’s abilities.
• The emotional tie along with a pattern of positive
interaction between the parent and child that
develops over time.
PFS Validity
The PFS was positively related to:
Effective coping skills
• Brief COPE
Physical and emotional health and functioning
• RAND 36-Item Health Survey (Adapted)
Positive emotions
• Positive and Negative Affectivity Scale – Short Form
Optimism
• Life Orientation Test-Revised
When PFS scores were high
In other words…
Effective coping was
high
Physical and emotional
health was good
Positive emotions
were high
Optimism was high
When PFS Scores Were High
Child abuse & neglect
potential was low
Stress was low
Depression was low
Negative emotions were low
Pessimism was low
PFS Pros and Cons
Pros
• Free and easy access.
• Established reliability
and validity.
• Manual and technical
assistance available.
• Can be broken into
subscales based on
needs.
• A reliable Spanish
adaptation is being
validated.
Cons
• No norms
established.
• Brief (not detailed
for any individual
factor).
• Not designed for
individual
assessment.
• Not designed to
measure small
changes resulting
from brief
interventions.
Threats to Accurate Evaluation
Outcomes were not well-defined with indicators:
• Example: What observable or reportable characteristics
represent “improved parenting skills” or “bonding”?
Outcomes/measures were not appropriate:
• Measure did not fit population or context.
• Anticipated outcomes are too long-term.
Inconsistent or lack of administration procedures
Too few surveys completed
Threats to Accurate Evaluation
Plan sufficient time for evaluation to minimize:
• Errors in data entry
• Less than honest or distracted reporting
• Consumers don’t take time to read and respond
accurately and fully (particularly true for post-tests)
Impact of outside factors:
• Improvement due to other interventions or changes.
• Decline due to external stressors or changes.
Group differences:
• Consumers from one group differ significantly from another
group (e.g., CPS-involved versus not).
Likelihood of Accurate Results
Tell consumers about evaluation and what to
expect ahead of time, if possible.
Use informed consent.
Provide adequate introduction and instructions.
Streamline! If you won’t use it, don’t ask it.
Use supervised administration, if possible.
Likelihood of Accurate Results
Consider using
alternative staff or
volunteers to
administer measures.
Train staff/volunteers to
explain purpose and use of
data collection and
confidentiality.
Use confidential
data entry and
analyses.
Allow for some anonymous
responses, if possible.
Allow enough time
as part of regular
session for survey
completion.
If possible, administer
surveys before the end of the
final contact.
Training Staff for Evaluation
Set
expectations for
all staff to:
Practice
administration
and handling
questions:
• Read the administration script
• Use consistent procedures
• Have new staff practice administration
with experienced staff/supervisor
• Occasionally monitor or follow-up
with staff to assure proper
administration
Some Simple Rules
Treat evaluation as part of service delivery.
Understand pros and cons of possible options.
Be consistent across time and consumers.
Account for your choice when analyzing and
reporting data.
Reflect results accurately.
When to Administer Pre-Test
st
1
Contact
After
st
1
Contact
Pro: Assess functioning
prior to any program
involvement.
Pro: May increase honest
responses due to
established
relationship/trust.
Con: Responses may be
less than honest do to lack
of trust/involvement w.
program
Con: May not capture
change occurring since 1st
contact
Retrospective Alternative
Cons
Pros
Allows for
time for
rapport and
trust
Educates
parents
about
perceptions
vs. reality
Fixes “what
I didn’t
know”
challenge
Not
included in
validity and
reliability
testing at
this time
Weaker
evidencebase in
evaluation
community
Can miss all
data if
participant
not present
at post
testing
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Guidelines
Make a program-wide decision
Administer consistently
Account for procedure when reporting
results.
Pre-tests administered at different times may
not be comparable.
Reverse Score Items
Ensure consumers do not feel rushed
Strongly encourage consumers to read survey items
closely
Instruction: Feel free to ask if the items are confusing to you
Consider addressing reverse-score items up front
“Some items ask about things your family doesn’t
have rather than things you do have. You may
answer these questions differently.”
Pre-Post Completion
Incentives to
complete
survey (e.g.,
dinner
provided, etc.).
Make the
survey available
over a broader
period of time.
Follow-up with
consumers
missed the
administration
of pre- or posttest.
Consider
reasons for
dropouts.
Was there a
data entry
problem?
Consider
retrospective
pre-test.
Dosage
More study needs to be done in this area—
Some preliminary observations of a limited number of
surveys indicate that dosage REALLY makes a
difference:
Across 3 states, respondents receiving 0-12 hours of
service decreases most parents’ scores at posttest.
Across 3 states, respondents receiving 20+ hours of
services improves parents’ scores at posttest.
More concrete guidelines are needed. The more
data we have the more we will know.
The Survey
Download from the FRIENDSnrc.org
under Outcome Accountability/
Protective Factors
• Tool
• User-manual
• FAQs
• Database
http://www.friendsnrc.org/protective-factors-survey
Presence on EB Registry
http://www.cebc4cw.org/assessment-tool/protective-factors-survey/
QUESTIONS ON THE PFS
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Your Current Work
Does your
current work plan
line up with PF?
How? Are there
gaps?
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Edi Winkle
[email protected]
(918)279-6682
www.friendsnrc.org
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