Identifying and Implementing Evidence Based (and Promising)

Practices

Child Welfare

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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 WelfareDiscussion

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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)

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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 )

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Evidence Based Practice Model

Clinical state and circumstances

Research EvidenceClinical Expertise

Client Preferences and Actions

Agency/ Partner Concerns

(Regehr, Barber, Trocme, Hart & Knoke, 2005)

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Implementing EBP within Child Welfare

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Challenges to Selecting and Implementing 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 Implementing EBP inHuman 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)

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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

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Treatment 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)

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Treatment 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)

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Levels of Evidence

Various ways to describe “Levels of Evidence” (Rosenthal, 2006 on page 71)

(1) Systematic reviews or meta analysis of multiple, well-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

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Treatment 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

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Treatment 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

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Child Welfare Evidence Based Treatment/Program Examples

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The Science of Assessment 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)

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Trauma Treatment

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)

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Trauma 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/

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Transition to Adulthood/Non-minor Dependency

Research studies defined the problem and indicate youths who stay in care until age 21 fare better

Fostering Connections Act = example of evidence based policy development

Few proven programs, but emerging consensus about EBP (Practices) for youth aging out of care Offer comprehensive array of services or connection to these services

(education, health, mental health, employment/training, financial literacy and asset building)

Provide individual case-management/mentoring Provide housing supports/housing

New promising evaluation results and planning for more evaluation

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Supportive Independent Living Programs

Youth Villages Transitional Living Program (MDRC) YVLifeSet = intensive, individualized, and clinically focused case

management, support, and services to young adults with histories of foster care or juvenile justice custody

Significant increases in housing stability and economic well-being and health and safety in comparison to the control group

Equally effective across different subgroups of youth No significant improvement in education, social support, or

criminal involvement. (Jackobs Valentine, Skemer, Courtney, 2015)

Evaluations in process Building Capacity to Evaluate Interventions for Youth/Young Adults

with Child Welfare Involvement at Risk of Homelessness (Mathematica)

California Youth Transitions to Adulthood Study (Mark Courtney)

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Education of Foster Children: Promising Practices

Little to no rigorous evaluation of educational practices demonstrating effectiveness with youth in care

Children in foster care are some of most vulnerable in the education system: High rates of repeating a grade by third grade High rates of school mobility Overrepresented in educational achievement gaps

Best available evidence comes from evaluations of programs implemented with other populations (Dworsky, Smithgall, Courtney, 2014)

What Works Clearinghousehttp://ies.ed.gov/ncee/wwc/aboutus.aspx

Guidelines and Practices within Child Welfare: Legal Center for Foster Care and Education: American Bar Association http://www.fostercareandeducation.org/Home.aspx

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Encouraging Use of Evidence Based Practice in Child Welfare

Practitioners/providers of services: Use clinical assessment tools and processes Engage in the EBP implementation process

Organization/Program Leadership: Support through policies, procedures, and incentives Procedures to support fidelity Access to technical assistance

Researchers, evaluators and intermediaries Understand user needs Build research into implementation.

Local, State, and Federal leaders Manage/minimize the effects of competing/conflicting policies Maximize opportunities for success by working across systems.

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1 .What is your experience with evidence based programming in child welfare and how does the content discussed here resonate?

2 .What characteristics of EB practice have you used in your child welfare work?

3 .What methods of EB practice have you found challenging to implement within child welfare? Why?

4 .How does your organization foster evidence based practice? What are the constraints?

Discussion

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References

Aarons G.A., Hurlburt M., Horwitz S.M. (2011) Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Mental Health. 38(1): 4-23. doi: 10.1007/s10488-010-0327-7.

Dworsky, Amy, Cheryl Smithgall, and Mark E. Courtney. 2014. “Supporting Youth Transitioning out of Foster Care, Issue Brief 1: Education Programs.” OPRE Report # 2014-66. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Paific Grove, CA: Brooks/Cole-Thompson Learning.

Jacobs Valentine, E., Skemer, M., Courtney, M. 2015. “Becoming Adults: One-Year Impact Findings from the Youth Villages Transitional Living Evaluation.” MDRC. New York, N.Y.

Mullen, E. J. & Streiner, D. L, (2006). The evidence for and against evidence based practice. Albert R. Roberts & Kenneth R. Yeager, editors. Foundations of evidence-based social work practice. New York, N.Y.: Oxford University Press.

Proctor, E. K. and Rosen, A. 2006. “Concise standards for developing evidence-based practice guidelines.” In Foundations of evidence-based social work practice Edited by: Roberts, A. R. and Yeager, K. R. 93–102. New York, NY: Oxford University Press.

Regehr, C. Barber, J. Trocmé, N. Hart, S. Knoke, D. (2005) An Evidence-Based Model for Risk Assessment in Child Welfare, SSHRC Research Cluster Grants, Concept Paper. University of Toronto: Centre for Applied Social Research.

Roberts, A.R., Yeager. K. & Regehr, C. (2006). Bridging evidence-based health care and social work: How to search for, develop, and use evidence-based studies. In A.R.,Roberts & K. Yeager (Eds.), Foundations of evidence-based social work practice (pp. 3-20). New York, N.Y.: Oxford University Press.

Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2 ed.). New York: Churchill Livingstone.

Saunders, B.E. (2013, May). So much trauma, so many interventions: How do we choose? Webinar presentation sponsored by the Chadwick Center for Children and Families and the California Evidence-Based Clearinghouse for Child Welfare, May 16, 2013, San Diego, CA.

Shlonsky, A., & Gibbs, L. (2004). Will the real evidence-based practice please stand up? Teaching the process of evidenced-based practice to helping professions. Brief Treatment and Crisis Intervention, 4(2), 137-153.