Building Evidence for Practice on How to Support Adolescents through a Comparative Tracking of their Perceived Social Support Outcomes Dr. Cormac Forkan,

Building Evidence for Practice on How to Support Adolescents

through a Comparative Tracking of their Perceived Social Support

Outcomes

Dr. Cormac Forkan,

School of Political Science and Sociology

and

Child and Family Research Centre

National University of Ireland, Galway

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Aims of Presentation

At the end of the presentation, we will have:

1.Examined the differences between Evidence-Informed and Evidence –Based Practice

2. Investigated a case study of how a project can introduce and utilise an evidence-based approach in their work, by engaging in a system of tracking the perceived social support levels among adolescents attending their project.

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Setting the Scene• Considerable public expenditure is

invested in a plethora of community-based youth and family interventions in Ireland on an annual basis.

• Despite this, there is very little known about the outcomes for children and young people attending these services in Ireland.

• Work in the Child and Family Research Centre – involves evaluating services and working with staff to introduce evidence-based practice.

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1. Evidence Based Practice

• Since development of Enlightenment, growth in use of reason as distinct from tradition or myth.

• Theological, Metaphysical and Positivist

• In more recent past, move towards adopting evidence-based policy methodology to decision making (Pawson, 2006)

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• 1969 – Donald T. Campbell noted rise of “experimenting society”

• Led to an experimental approach to social reform

– New programmes were implemented and monitored around discerning outcomes for service users

• Nowadays – professional views alone now replaced by demand for supporting evidence

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• Evidential approach – avoids situation from the past when everyone knew the word the flat!

• Coleman (2003) describes process as shift towards results-based accountability

• Using an evidence-based approach provides the potential for more practitioners to use evidence in their daily work.

• Evidence-based Practice is grounded in rationality, is focussed on quality of care and cost effectiveness.

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• In the clinical setting, an evidence-based approach brings services more in line with the best available clinical science evidence, using practices that are shown to be safe and effective (Chaffin and Friedrich, 2004)

• So, what constitutes evidence?

• Kazdin and Weiss (2003) define ‘evidence’ as replicable procedures that have outcomes that can be reproduced by others

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• Accepted that most reliable form of knowledge is generated by Randomised Control Trials (RCT’s)– Big Brother Big Sister Programme

Evaluation in Ireland (Brady et al, 2010)

• 1st RCT conducted on a youth intervention in Ireland

• Control and Intervention Group

• Compared differences over time

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• The opposite to Evidence-Based Practice is Evidence-Informed Practice (Veerman & Van Yperen, 2007)

• Gut-based knowledge

• More subjective than objective

• Driven by personal values and fads of the time

• Gathered over time in the field by the person

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• Scared Straight Boot Camps– Run for juvenile delinquents in US

– Controlled outcomes research – confirmed camps did not produce any better, but worse outcomes

– Initial underlying rationale for camps was evidence-informed, gut based (Petrosino, Turpin-Petrosino and Finckenauer, 2000)

– Therefore, obvious dangers with evidence-informed practice

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“Thus, in the traditional evidence-informed practice culture, we can expect only that tomorrow’s interventions will look different from today’s – we cannot confidently expect that they will work any better”.

Chaffin and Friedrich (2004:1100)

• See Table- Contrasting Evidence Based Practice with Traditional Practice

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Table 1: Contrasting evidence-based practice with traditional evidence-informed practice

Source: Chaffin and Friedrich (2004:1101)

• So, what evidence exists for interventions for children and adolescents?

• Kazdin (2000) found that there were 1500 controlled investigations of interventions.– Only 40-50 of those underwent RCT

evaluations

– Therefore, a considerable number of the interventions used with young people on an everyday basis have no RCT based empirically sound information

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• Veerman and van Yperen (2007) suggest only very few interventions in this area have been sufficiently evaluated

• Furthermore, due to excessive costs, recruitment of participants and ethical issues, most interventions will never be included in an RCT evaluation

• Therefore, the majority of evidence created by projects relating to the effectiveness of their interventions will at best be evidence-informed and not evidence-based.

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• Considering the need to still have evidence, albeit not always RCT based, to bridge the gap Veerman and van Yperen (2007) developed a model

• Evidence generated from youth and family based projects could be categorised on a four point scale, ranging from minimum level evidence to the higher-end RCT gold standard level of evidence

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Table 2: Levels of evidence, parameters of evidence, types of research and effectiveness of interventions

2. A Case Study

• Author located a family support project in North-West of Ireland wiling to participate in study.

• Apart from throughput data, complimented by qualitative commentary, no outcomes data were routinely collected by the Project staff.

• Therefore the project was operating along evidence-informed lines.

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2. Case Study• Study explored how the project

could for the first time:– introduce and utilise an evidence-

based approach to their work

– by engaging in a system of tracking the perceived social support levels among service users over a one year period.

• This would generate indicative evidence (level 3) for the Project, which would help them to become evidence-based in their work.

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•All children attending the All children attending the project invited to partcipate project invited to partcipate (n=22 agreed)(n=22 agreed)

•Tool used was the Tool used was the Social Social Provisions Scale Provisions Scale (Cutrona (Cutrona & Dolan, 2002)& Dolan, 2002)

•Measures the Measures the typetype of of social support as well as social support as well as the the sourcessources of it ( of it (Parents, Parents, Siblings, Friends & any Siblings, Friends & any other adult):other adult):

•Types of Support are:Types of Support are:Concrete supportConcrete support: : e.g. e.g. childmindingchildmindingEmotional supportEmotional support: : e.g. e.g. listening to a friend who is listening to a friend who is upsetupsetAdvice supportAdvice support: : e.g. e.g. helping to make a big helping to make a big decisiondecisionEsteem supportEsteem support: : e.g. e.g. assuring someone who has assuring someone who has studied hard for an examstudied hard for an exam

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• Key findings:

– Parents were the best perceived source of support at both T1 & T2

– Friends were the second best source of support, followed by Other Adults

– Siblings were the worst form of support at both T1 & T2

– Esteem support was low for all respondents at both T1 & T2.

2. Case Study

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Figure 1: Change in the Mean Perceived Social Support Score at T1 and T2 by Sources and Types of Support for SP Respondents

TimeTime 2Time 1

Mean

100

90

80

70

60

Siblings Springboard

Other Adults Springboard

Friends SpringboardParents Springboard

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Figure 2: Change in the Mean Perceived Social Support Score Between T1 and T2 by Sources and Types of

Support for SP Respondents

Source of SupportSiblingsOther AdultFriendsParents

Mean

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10

0

-10

-20

-30

0.0

AdviceEsteemEmotionalConcrete

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3. Implications for Practice

• Prior to this study the Project did not monitoring outcomes for their adolescents – was evidence-informed rather than being evidence-based.

• Key Findings revealed:1. Perceived availability of high

levels of social support over time2. Parents perceived as the

strongest source of social support3. Consistent patterns in perceived

social support from other sources23

• For the first time the Project now had an evidence base from which to work.‘Family support can be a critical resource for parents and children who are striving to overcome adverse circumstances. However, supportive interventions are not always effective … support is most effective from those with whom we share close emotional bonds. Thus, the … professional’s first priority should be facilitating the flow of support within the existing social networks of family and friends, rather than trying to “graft on” new sources of support … In general, support that communicates genuine caring, yet encourages the individual to solve his or her own problems is most effective.’ Cutrona (2000:120)

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Evidence Informed Approach Evidence Based ApproachIndicative Evidence

Potential Modes of OperationYouth and Family Support Projects

Successful Adolescent

Development

Society(Macro Level)

Schools – Projects – Community(Meso Level)

ParentsSiblings – Peers – Other Adults

(Micro Level)

Longitudinal Measurement of Social Support of

Adolescents

Optimal Matching

Perceived Social Support(Concrete, Emotional, Advice, Esteem)

Successful Adolescent

Development

Perceived Social Support(Concrete, Emotional, Advice, Esteem)

NO Longitudinal Measurement of Social Support of Adolescents

Society(Macro Level)

Schools – Projects – Community(Meso Level)

ParentsSiblings – Peers – Other Adults

(Micro Level)

The bottom line for all youth and family practitioners is:

– Realise that what you do does make a difference

– Avoid paralysis by analysis syndrome (Oh, I wonder or I can’t…)

– Believe you can bring about change

– Using an evidence-based approach will aid the change process and helps you be proud of your work and be subject to accountability

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Documents

Building Evidence for Practice on How to Support Adolescents through a Comparative Tracking of their Perceived Social Support Outcomes Dr. Cormac Forkan,