Transcript Using Research in Practice - Northern California Training

Using Research in Practice: The
Benefits of Using Literature Reviews
to Guide the Peer Quality Case Review
Process
Susan Brooks
Northern California Training Academy
August 2009
What we’ll look at…
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Why evidence matters
The benefits of using research evidence in practice
How research can be used
Factors that help & hinder evidence use
Some examples of using research to inform the Peer
Quality Case Review Process
*Material adapted from Module 1 of The Evidence Guide, Barnardo’s, 2006
Why make use of evidence?
By making research work better for services we can:
Improve outcomes for service users & avoid investing in
approaches that make no apparent difference
 Improve accountability to stakeholders
 Increase objectivity and fairness in decision-making
 Increase confidence in and quality of decisions
 Develop good practice and increase the credibility of services
 Develop more skilful and knowledgeable practitioners
 Question ourselves and our beliefs and have their worth confirmed,
or discard them as appropriate
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(The Evidence Guide, Barnardo’s, 2006)
Some questions for services
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How are services planned?
What information/evidence is used?
How relevant and current is it?
How do we know services ‘work’?
Is it the best way?
What are the alternatives?
(The Evidence Guide, Barnardo’s, 2006)
How can research be used?
To help staff understand
the needs of service users
To illustrate ‘what works’
To make the reasons for decisions
about services transparent.
To inform service users and carers
of what the research says
To help decide which
interventions or services to support
To provide staff with
new and innovative practice ideas
See: Macdonald (2001)
Models of increasing
research use
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The research-based practitioner model
Focus on professional education & training to develop practitioners'
skills in using research.
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The embedded research model
Evidence about 'what works' becomes embedded in
policies, guidelines and practice tools
(Approach used in the Peer Quality Case Review Process)
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The organisational excellence model
Emphasis on developing a 'research-minded' culture within the
organisation.
SCIE Knowledge Review, Walter et al, 2004
Levels of Evidence
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Effective-achieves child/family outcomes, based on
controlled research (random assignment), with
independent replication in usual care settings
Efficacious-achieves child/family outcomes, based on
controlled research (random assignment), independent
replication in controlled settings
Not effective- significant evidence of a null, negative,
or harmful effect
Promising-some positive research evidence, quasiexperimental, of success and/or expert consensus
(typically what is cited in child welfare research)
Emerging -recognizable as a distinct practice with
“face” validity or common sense test
Using research to INFORM practices
Contextual
Assessment
Client
Preference
or Willing to
Try?
Cultural
Barriers?
Appropriate for
this client?
Clinical State &
Circumstances
Clinical Expertise
Client
Preferences
and Actions
Source: Shlonsky and Wagner, 2005
Research
Evidence
Valid
Assessment?
Effective
Services
Overall Purpose of the Peer Quality
Case Review
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PQCR increases understanding of local
practice
Informs SIP strategies
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(Practice changes & system changes that support
changed practices)
Use literature reviews (the research) to better
inform the practice of attaining understanding
of local practices and SIP strategies
Example of using a literature for the
Peer Quality Case Review
Factors, Characteristics, and Practices Related
to Former Foster Youth and Independent Living
Programs: A Literature Review
Purpose of this Review:
Examine:
• Factors related to experiences former foster youth face in
transitioning to independent living
• Characteristics of Independent Living Programs (ILPs)
• Factors related to successful transitions for former foster youth
Use this review to guide county Peer Quality Case Reviews (PQCRs)
• Case Review Tools
• Interview Tools
Background on Emancipating Foster Youth
Some of most vulnerable citizens in
California due to higher rates of:
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High school drop outs
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Homelessness
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Criminal Involvement
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Hospitalization for injury
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Risk for mortality and morbidity
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Dying from violence and accidents
(Barth, 1990; Piliavin, Wright, Mare, & Westerfelt, 1996; Sabotta
& Davis, 1992; Widom, Ireland, & Glynn, 1995)
Routes for Exiting Foster Care
Majority exit when reunited with families,
adopted, or emancipated
Alternate routes: running away,
incarceration, entering psychiatric hospital, or
death (Courtney & Barth, 1996)
10,363 foster youth ages 16-18 exited all
types of care in California in 2008 (Needell et al., 2009)
Understanding the Transition to Exiting
Foster Care
1st step: Examining conditions and characteristics
that lead to each type of exit
• Factors associated with method of exiting foster care:
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# of foster care spells (time between entry and exit)
# of weeks in foster care
Type of last placement
Understanding the Transition to Exiting
Foster Care (continued)
High # of spells in foster care associated with unsuccessful exit
Youths who spend more time in foster care are more likely to be emancipated
Placement in group care associated with lower chance of emancipation
McCoy, McMillen & Spitznagel (2008):
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Some youth discharged prematurely for arbitrary reasons and/or without
notice
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Troubled youth (those with behavior problems, drug & alcohol
consumption), youth with multiple placements in last year, and youth with
history of living on streets leave care earlier than other youth
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Study suggests most troubled youth need early services to prepare them for
transition to independence or an Independent Living Program (ILP)
Independent Living Programs
Assists current and former foster
youth to become self-sufficient in
transition out of foster care system
(Foster Care Independence Act of
1999)
Those eligible:
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Foster youth prior to day before
21st birthday
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Foster youth in system between
their 16th and 19th birthday
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Youth participated in Kinship
Guardianship Assistance
Payment Program (Kin-GAP)
ILP services in CA:
• Housing assistance
• Employment assistance
• Educational resources
• Financial assistance with
college/vocational schools
• Daily living skills
• Money management
• Decision making
• Self esteem programs
Benefits of ILPs
ILP youth (vs. other foster care) in California:
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More likely to receive information about
financial aid in high school
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Significantly younger when beginning
college
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Receive information on training
associated with independent living:
opening bank account, obtaining care
insurance, balancing checkbook, finding
place to live
(Lemon, Hines, & Merdinger, 2005)
Factors Associated with Successful
Transitions
Resilience factors for foster youth in transition to adulthood and
independent living (Daining & DePanfilis, 2007):
Child Factors:
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Gender: Females have higher rates of success than males
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Age: Youth with an older age at exit have higher rates of success
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Mental Health: Youth with lower levels of perceived stress have higher
rates of success
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Relationships with Family: Higher levels of social support from friends
and family associated with greater resilience
Factors Associated with Successful
Transitions (continued)
Mentoring Relationships:
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75% of former foster youth identified supportive, non-kin mentor – but 25% of youth
could not (Munson & McMillen, 2009)
Having a mentor associated with fewer symptoms of depression, less perceived
stress, and greater satisfaction with life 6 months later (Munson & McMillen, 2009)
Support of long-term mentor associated with lower likelihood of being arrested and
less perceived stress (Munson & McMillen, 2009)
Researchers suggest mentors be included in service provision process – inform
mentors about resources available to foster youth and provide funds to buy youth
necessary instrumental items (Greeson & Bowen, 2008)
Factors Associated with Successful
Transitions (continued)
Service/Program Factors:
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Different outcomes for residential education (e.g. boarding schools) vs.
therapeutic residential treatment programs
Residential education programs place emphasis on education (Barth & Lee,
2009)
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50% of youth enrolled in these schools enter college
19% enter vocational program or military
18% enter the workforce
These programs provide lengths of stay that promote educational stability,
encourage family involvement in youth’s education, and provide familytype environment with live-in house parents
Viable alternative for foster youth facing instability in the system, but who
are committed to education
ILPs and Youth Outcomes
Research suggests ILPs are beneficial for youth (Montgomery,
Donkoh, & Underhill, 2005)
Nearly all studies report higher rates of high school enrollment and
completion, and vocational school or college attendance
Majority of studies report positive associations with employment
outcomes
All studies reported generally favorable housing outcomes (e.g. living
independently and paying own expenses)
Limited/Inconclusive research in associations between ILPs and
homelessness, health outcomes, criminality, and self-sufficiency
Future Focuses for ILPs
Focus on access to stable
housing
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Collaborations with local housing
providers, local landlords,
subsidized rent (Naccarato &
DeLorenzo, 2008)
Focus on educational stability
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Emphasize birth family
involvement in education
throughout educational career
High teacher and case worker’s
expectations for achievement
Connections between child
welfare agencies and schools
(Naccarato & DeLorenzo, 2008)
Future Focuses for ILPs (continued)
Focus on establishing/maintaining supportive relationships
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Find suitable foster families for most troubled youth
Incorporate relationship building services into ILPs (e.g. relationshipfocused therapy) (Berscheid, 2003)
Focus on employment experiences
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Emphasize vocational training and formal training programs that result in
employment
Collaborations between child welfare agencies and employers can promote
long-term, stable employment opportunities for former foster youth
(Naccarato & DeLorenzo, 2008)
California’s Regional Occupational Program offers variety of
educational/job training services throughout local school districts with more
than 100 occupational areas
Specific Recommendations for ILPs
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Develop and provide ILPs tailored to needs of each youth with clear
goals and outcomes
Provide aftercare services post-discharge, especially case
management and crisis intervention
Collaborate with caregivers and other service providers responsible
for youth
Develop and maintain sufficient housing programs
Encourage youth to attend and complete college
Do not set low expectations for foster youth
Share information about effective ILP strategies and practices
amongst ILP coordinators
(Naccarato & DeLorenzo, 2008)
Promising Practices
Use of mentors and advocates!
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Provide emotional and instrumental support
Advocate enrollment and continued participation in ILPs for youth
Provide a reliable network for assessing needs and services
Early introduction of ILP services
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Youth need ILP services long before they are ready to emancipate
Most troubled youth likely to exit system unsuccessfully around the time
they become eligible for an ILP
ILP services should start as youth enter adolescence
Youth should be a part of the decision making process for their transition
Applications for the Construction of Case
Review and Interview Tools
We know that…
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Foster youth that are older have higher success rates than
those that exit the system at younger ages
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Question: What services does our county offer to encourage
and promote youths’ willingness to stay in the system to meet
eligibility requirements for ILPs?
For a specific case review: What range of services did this
child receive prior to exiting foster care?
Applications for the Construction of Case
Review and Interview Tools
We know that…
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Mentoring relationships are vital for youth both during and
after exiting foster care
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Question: What type of advising/mentoring services does our
county provide for youth in the foster care system and upon
entering into ILPs?
For a specific case review: Was this child offered any
opportunities for developing mentoring relationships?
Applications for the Construction of Case
Review and Interview Tools
We know that…
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Youth need ILP services long before they are
ready to emancipate
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Question: What type of services are foster youth provided and
when are they receiving them?
For a specific case review: What services related to
independent living did this child receive and how long did the
child have to wait before receiving such services?
Inform Focus Groups for PQCR
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Who to include
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Based on the literature,
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Have a group of foster youth who recently emancipated
Have a group of foster youth who are currently receiving ILP
services and have not emancipated
If feasible include a group of youth participating in residential
education programs and therapeutic residential programs
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Also include a group of staff who work in these two different
residential settings
Conclusion
Former foster youth are at a distinct disadvantage in early adulthood in the areas of
education, housing, employment, economics, and health - BUT…
Research suggests ILPs positively contribute to youth outcomes in domains of
education and employment
Focus on early enrollment in ILPs, fostering mentor relationships, and providing
extended aftercare services!