Transcript Document

www.cachildwelfareclearinghouse.org
Child Welfare Conference
Monterey, 2008
Charles Wilson, MSSW Executive Director
Laine Alexandra LCSW, Project Manager CEBC
Goals for Today’s Session
• Discuss the Importance of Evidence-Based Practice
(EBP) and how it relates to Child Welfare.
• Define EBP and determine the level of empirical
support that exists when selecting the best practice.
• Identify some of the emerging challenges with EBPs
and learn some successful strategies to overcome them.
• Understand at least five key factors necessary for
successful implementation of a new practice.
Lots of Terms Exist
• Innovative Practice
• Emerging Practice
• Promising Practice
But what do they mean?
• Good Practice
• Demonstrated Effective Practice
• Best Practice
• Empirically-Based Practice
• Evidence-Informed Practice
• Evidence-Supportive Practice
• Evidence-Based Practice
Defining Evidence-Based Practice
Global Definition of EBP
The conscientious, explicit, and judicious use of current best
evidence in making decisions about the care of individual patients.
Including Both
Individual clinical expertise
The best available clinical
evidence from systematic
research
-David Sackett, M.D. 1996
CEBC’s Definition of EBP
for Child Welfare
Best Research
Evidence
Best Clinical
Experience
EBP
Consistent with
Family/ Client
Values
(modified from Dr. David Sackett’s definition)
Why Is Evidence-Based Practice
Important?
Why Evidence-Based Practice Now?
• A growing body of scientific knowledge allows us to take a
closer look at practices.
• Increased understanding of the fiscal implications of not using
EBP.
• Increased interest in outcomes and accountability by funders.
• Increased interest in consistent application of quality services.
• Past missteps in spreading untested “best practices” that turned
out not to be as effective as advertised.
• Continuing focus on safety and effectiveness of interventions.
• Because they work !!
So how do we know what works?
Let the Buyer Beware
Thought Field Therapy
“Thought field therapy with Callahan techniques® is a powerful therapy
exerted through nature's healing system to balance the body's energy system.
This therapy promotes stress management and stress relief as well as the
reduction or elimination of anxiety and anxiety related problems. This includes
help
for weight
control and weight loss, trauma or sleep difficulties,
Roger
J. Callahan,
PhD
depression, addictions and the disorders associated with past trauma including
nightmares and post traumatic stress disorder.” (underlines added)
Retrieved from http://www.tftrx.com/,
November 17, 2006
More Claims for TFT
“Q. How Can TFT Benefit You? – What Kind of Problems Can Be Helped?
•
•
•
•
•
•
•
•
•
•
•
Anxiety and Stress
Personal fears or your children’s fears
Anger and Frustration
Eating or smoking or drinking problems
Loss of loved ones
Social or public speaking fears
Sexual or intimacy problems
Travel anxiety including fear of flying or driving on the freeways
Nail biting
Cravings
Low moods and mood swings”
Retrieved from http://www.tftrx.com/profaq.php?PHPSESSID=
f4cf66c40b9678b742b82989fee7b377# on November 17, 2006
Emotional Freedom Techniques
“TFT uses similar principles as EFT but asks the student to learn 10 or
15
different
tapping routines
(called
each
of provided
which
is
“Based
on impressive
new is
discoveries
regarding
subtle
“EFT
based
on aalgorithms),
new
discoverythe
thatbody's
has
designed
cover a specific
issue
trauma,
phobias,
energies, to
Emotional
Freedom
Techniques
(EFT)
has
proven
successful
thousands
withsuch
relief as
from
pain, diseases
and depression,
emotional
issues.
Simply
stated,
ittoisjust
an emotional
version
of
etc
. Anythingofnot
covered
by
those
individual
routines
(e.g.emotional,
insomnia,
in thousands
clinical
cases.
It applies
about every
acupuncture
except needles
aren't necessary..”
TMJ,
etc.) requires
diagnostic
process.
contrast,
uses
healthdyslexia,
and performance
issueayou
can name
and
it EFT,
oftenby
works
where
only
one else
comprehensive
tappingoff
routine
cover allStatement
issues (not
nothing
will.
“It launches
the EFTtoDiscovery
whichjust 10
For15)
proof,
is arequire
sampling
ofcause
our actual
cases.emotions
They are
for
or
and here
doesn't
diagnosis.
” all negative
says..."The
of
is awritten
disruption
in thephysicians
body's energyand
system.“
you by everyday citizens,
therapists: Pain Management,
Addictions,
Weight
Allergies,
Children's
Animals, Vision,
“EFT often
doesloss,
the
job for you
cleanlyIssues,
and thoroughly
in
And because our physical pains and diseases are so
Headaches,
Panic/Anxiety,
Asthma,
Trauma,
PTSD,
Depression,
one or two
sessions
... and
sometimes
does
it inAbuse,
moments.
obviously
connected
with our
emotions
the following We
Dyslexia,
Carpal
Tunnel,
Anger,
Eating
Gary
Craig
statement
hasADD-ADHD,
also proven
beFears/phobias,
true...
"Our unresolved
label these
latter
near-instant
results
asto"one
minute
wonders."
disorders, OCD, Bloodnegative
Pressure,
Diabetes,
Neuropathy,
emotions
are major
contributors Fear
to mostof Flying,
Do EFT properly and
you
will
likely
experience
them
50% of
physical pains
and diseases."
Claustrophobia, Agoraphobia,
Anorexia/Bulimia,
Sports and other
the time.”
Performance”
Retrieved from http://www.emofree.com/ October 26, 2007
Success Stories
Testimonial from AW from Trinidad & Tobago - “I visited
a therapist who did some regression with me and
“PTSD (Post
Stress
Disorder)
responds
discovered
one ofTraumatic
my deep-seated
emotional
blocks
surprisingly
EFT.
In months
most cases
the intense
“Dr.when
Patricia
Carrington
provides
occurred
Iwell
was to
about
seven
old. Apparently
from
those
flashbacks
usthen
with
the
story reasons
of and
"Claude"
I feelings
was hurt
and
for whatever
atintrusive
the time, my
cries
for attention
went
unheeded
bymaterially
thefish
adults rose
around
memories
either
vanish
are
reduced
whose
ability
toorcatch
me.”
within a few minutes of applying EFT. Also,
”
dramatically
after
EFT. these
repeated
applications of
EFTusing
often eliminate
Now AW “uses EFT by tuning into herself at 7 months of
feelings
permanently
so girl's
that they
no longer
age
and tapping
on that little
unhealed
issues. reappear on a daily, weekly or monthly basis.”
Success!”
Retrieved from http://www.emofree.com/ October 26, 2007
Waiting Room Sign
Ben Saunders
MUSC
Understanding the CEBC
The CEBC
In 2004, the California Department of Social
Services, Office of Child Abuse Prevention
contracted with the Chadwick Center for Children
and Families, Rady Children’s Hospital-San Diego
in cooperation with the Child and Adolescent
Services Research Center to create the CEBC.
The CEBC was launched on 6/15/06.
Scientific Rating Process
The Scientific Rating Scale
and
Relevance to Child Welfare Scale
Scientific Rating Scale
Relevance to Child Welfare Scale
1.
1.
High:
The program was designed or is commonly used to meet the needs of
children, youth, young adults, and/or families receiving child welfare
services.
2.
Medium:
The program was designed or is commonly used to serve children, youth,
young adults, and/or families who are similar to child welfare
populations (i.e. in history, demographics, or presenting problems) and
likely included current and former child welfare services recipients.
3.
Low:
The program was designed to serve children, youth, young adults, and/or
families with little apparent similarity to the child welfare services
population.
Topics Currently Available
on the Website
•
Parent Training
•
Trauma Treatment for Children
•
Reunification Services
•
Parental Substance Abuse
•
Youth Transitioning to Adulthood
•
Family Engagement/Motivation
Topics Currently Available
on the Website
•
DV Services Batterers Treatment
•
DV Services for Women and Children
•
Placement Stabilization
•
Supervised Visitation
•
Prevention
Topics Currently Available
on the Website
•
Interventions for Neglect
•
Home Visiting for School Readiness
•
Casework Practice
Next Set of Topics to be
Reviewed and Rated
•
Home Visiting for the Prevention
of Child Abuse and Neglect
•
Higher Level of Placement
•
Child Welfare Initiatives
•
Programs added in existing topic
areas
Topic Areas and Resources
Fiscal Year 2008/2009
•
Resource Parent Recruitment and
Training
•
Assessment/Screening Tools
•
Post Permanency Services
•
Treatment for Mental Health Disorders
In Children and Adolescents
•
Implementation Resources
Number of Programs per Rating Category
Total Number of Programs is 85
60
50
40
30
20
10
0
1
Effective Practice
2
3
4
5
6
Concerning Practice
Programs Rated “1”
Well Supported by Research Evidence
Home Visiting
Nurse Family Partnership
Parent Training
Parent-Child Interaction Therapy (PCIT)
The Incredible Years
Triple P
Placement Stabilization
Multidimensional Treatment Foster Care (MTFC)
Substance Abuse (Parental)
Motivational Interviewing
Trauma Treatment
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Lucy!
http://www.youtube.com/watch?v=4wp3m1v
g06Q
Laying the Ground Work for
Implementing EBPs
Research on Implementation
• Historically, there has been little research in
the field of child welfare regarding the
effectiveness of implementation
approaches.
• Currently, there is an increased focus on
conducting research on the implementation
efforts that are underway.
What are some of the Challenges with
Evidence-Based Practices?
Levels of Implementation
• Paper
• Process
• Performance
Fixsen, D., Naoosm, S., Blasé,
K., Friedman, R., Wallace, F. (2005)
http://nirn.fmhi.usf.edu
Challenges with EBPs
• Agency and staff buy-in concurrent
with existing workloads
Challenges with EBPs
• Cultural Issues
Challenges with EBPs
• State and local government pressure
to act now- demand for action
Challenges with EBPs
• Training for providers:
• Costs (initial and continuing)
• Availability
• Propriety and licensing Fees
Challenges with EBPs
• Staff retention of trained personnel
Challenges with EBPs
• Buy in!
(how to get it) especially among different
classifications.
Challenges with EBPs
• Need for more research in child
welfare
Challenges with EBPs
• It is challenging to shift culture,
practice attitudes and bias.
Challenges with EBPs
• EBP may feel like the next “flavor”
of the month”
Key Factors for the Implementation of
an EBP
Assessment of Community Needs
Assessment of Community Needs
• Determine the needs of the
community and choose a target
problem to address
• Initial Community Preparation for
EBP
Selection
• Preliminary Community
Preparation
• Selection of an EBP which addresses
the identified problem
Organizational Readiness
• Utilize Organizational
Readiness Tools
• Establish an Executive Team of
Powerful Stakeholders
• Create a Learning
Organization
Training/Skills
•Learning EBP Skills
•Mastery
•Fidelity
Spread
• Sustainability
• Institutionalization
For
More
Information:
Laine Alexandra, LCSW, Project Manager
Chadwick Center- Rady Children’s Hospital-San Diego
Cambria Rose, LCSW, Project Coordinator
Chadwick Center- Rady Children’s Hospital-San Diego
CEBC E-Mail: [email protected]
CEBC Website:www.cachildwelfareclearinghouse.org