Child Welfare Outcomes in Counselling Practice€¦ · Child Welfare Outcomes in Counselling Practice Dr. Robbie Babins-Wagner, RSW CEO, Calgary Counselling Centre Adjunct Professor,

Child Welfare Outcomes in Counselling Practice

Dr. Robbie Babins-Wagner, RSW

CEO, Calgary Counselling Centre

Adjunct Professor, University of Calgary,

Faculty of Social Work

Acknowledgements:

• Tiffany Beks & Stephanie Korol, Research Assistants, CCC

• Sandy Berzins, Manager, Research & Outcomes, CCC

• The clients who participated in the counselling program at CCC.

International Conference on Child Maltreatment, May 4-7, Calgary, AB

Overview • Child Welfare research literature generally focuses on child

outcomes, followed by family outcomes and parent outcomes. • These include:

– mental health outcomes, and mental health and addictions outcomes – parent depression symptoms – rates of re-referral – parent-child dysfunction, etc. – child behaviour problems – parenting programs

• There is a small literature base that speaks to readiness to change. • There were no studies that focused on the outcomes of counselling

services for child welfare clients.


Readiness for Change (Stages of Change)

• Tells WHEN people change

• Index of readiness

• Predicts who will change successfully

• Guides client-treatment matching

• A dynamic, not static, client characteristic

• Inclusive, empathic, optimistic

International Conference on Child

Maltreatment, May 4-7, Calgary, AB

The Transtheoretical Model

• There are five (5) well-defined stages of change

• Theory suggests that individuals differ in their readiness or openness to make changes to their behaviour

• Individuals relapse and recycle through the stages quite frequently as they attempt to modify or cease behaviours (Prochaska, et al., 1992)

• Stage-specific strategies and processes of change

• Most programs are action-oriented, but most people are not


The Transtheoretical Model of Change • Stage of change

– Precontemplation

– Contemplation

– Preparation

– Action

– Maintenance

– Termination

• Decisional balance

• Self-efficacy

• Processes of change

• Processes of resistance


• Readiness for change is a focus of interest as it has been linked to engagement in treatment services

• Calgary Counselling Centre has a long history of using readiness for change measures for both counselling and domestic abuse treatment


Research Framework • The study employs tenets of Practice Based Evidence

(Barkham & Margison, 2007) whereby the research questions are grounded in the practice context and need to be relevant to practitioners and the delivery of routine services.


Research Questions

• What is the relationship between readiness for change and client outcome among a sample of Calgary Counselling Centre clients referred by Child Welfare?

• Does readiness for change predict client outcome?


Research Measures & Variables

• The measures are those used by Calgary Counselling Centre in routine practice

• Outcome Questionnaire 45 (Lambert et al, 2003)

• URICA – G (McConnaughy, Prochaska, & Velicer, 1983)

• Demographic Variables: Problem, Age, Gender, Marital Status, Education, Employment, Income, Ethnicity


Data Analysis • 500 cases referred to Calgary Counselling Centre between

2005 and 2011 for counselling as part of a service agreement

• The study employs a pre/post-test design

• 182 cases had a first and last session outcome data and an initial Stage of Change Score

• Paired t-test was used to understand change between first session OQ and final session OQ

• ANOVA was used to understand the relationship between the stage of change at the first session, first session distress and final outcome



Age

Age Child Welfare

Cases Family

Violence Cases CCC Cases

Up to 17 4 (2.3%) 2 (.2%) 59 (.5%)

18-24 25 (14.6%) 189 (16%) 2167 (18.8%)

25-29 32 (18.7%) 201 (17%) 2731 (23.6%)

30-39 67 (39.2%) 377 (31.9%) 3329 (28.8%)

40-49 38 (22.8%) 265 (22.4%) 1992 (17.2%)

50 and up 4 (2.3%) 148 (12.5%) 1271 (11%)

Total 171 1182 11,549

Mean 33.3 35.7 34.1 ACSW Confenrce March 28, 2013

Income Child Welfare Cases

CCC Cases

0 (no income or not reported)

89 (53.9%) 327 (28.4%) 3475 (31.5%)

$1-$29,999 44 (26.7%) 393 (34.1%) 4251 (38.6%)

$30,000-$49,999 17 (10.3%) 225 (19.5%) 1741 (15.8%)

$50,000-$69,999 7 (4.2%) 99 (8.6%) 662 (6%)

$70,000-$89,999 6 (3.6%) 41 (3.6%) 354 (3.2%)

$90, 000+ 2 (1.2%) 66 (5.7%) 537 (4.9%)

Total 165 1151 11,021

Mean Income $14,323 $28,234 $24,094

Median Income 0 $20,000 $14,400


Gender

• Number • Percent

Child Welfare

Cases

Family Violence

Cases

CCC Cases

Male 71 (36.9%)

1153 (97.3%)

3786 (32.5%)

Female 107 (60.1%)

32 (2.7%)

7857 (67.5%)

Total 178 1,185 11,643


Marital Status

Child Welfare Cases

Family Violence Cases

CCC Cases

Married or Common Law

58 (36%) 420 (38.5%) 3033 (28.4%)

Separated 33 (20.5%) 147 (13.5%) 1236 (11.6%)

Divorced or Widowed

8 (5%) 41 (4.7%) 895 (8.4%)

Single 60 (37.3%) 415 (38%) 4976 (46.6%)

Engaged or Partners

2 (1.2%) 59 (5.4%) 548 (5.1%)

Total 161 1,092 10,688


Employment

Child Welfare Cases


CCC Cases

Employed Full Time

41 (36%) 637 (61.2%)

4887 (48.2%)

Employed Part Time

20 (17.5%) 194 (18.6%) 2092 (20.6%)

Unemployed 47 (41.2%) 169 (16.2%) 2353 (23.2%)

On Disability Leave

3 (2.6%) 22 (2.1%) 373 (3.7%)

Full Time Students

3 (2.6%) 19 (1.8%) 439 (4.3%)

Total

114 1,041 10,144 International Conference on Child


Education

Child Welfare Cases


CCC Cases

Less than Grade 8

3 (2.6%) 29 (2.8%) 171 (1.7%)

Grades 9-12 71 (61.7%) 470 (45.9%) 3009 (29.7%)

Technical Vocational

6 (5.2%) 154 (15%) 1011 (10.9%)

University or College

35 (30.4%) 372 (36.3%) 5858 (57.8%)

Total 115 1025 10,139

ACSW Confenrce March 28, 2013

Ethnicity

Child Welfare

Cases

Family Violence

Cases

CCC Cases

European 21 (17.2%) 145 (13.8%) 1692 (16.5%)

English/Canadian 72 (59%) 605 (57.7%) 6660 (65%)

Asian 3 (2.5%) 93 (8.9%) 536 (5.2%)

Aboriginal 12 (9.8%) 30 (2.9%) 159 (1.6%)

Other 14 (11.5%) 175 (16.7%) 1205 (11.8%)

Total 122 1,048 10,252


Client Identified Presenting Problem

Child Welfare

Cases

Family Violence

Cases

CCC Cases

Couple Marital 10 (5.7%) 71 (6%) 1228 (11.2%)

Spouse Abuse 37 (21.3%) 652 (55.5%) 524 (4.8%)

Family Relations 29 (16.7%) 15 (1.3%) 603 (5.5%)

Parenting Skills 29 (16.7%) 8 (.7%) 119 (1.1%)

Child Abuse/Neglect

15 (8.3%) 12 (1%) 128 (1%)

Other 60 (33.3%) 431 (36.7%) 9082 (77.7%)

Total 180 1,174 11684


Number of Sessions

Child Welfare Cases


CCC Cases

1 20 (11.1%) 159 (13.4%) 2578 (22.1%)

2 13 (7.2%) 143 (12%) 1912 (16.4%)

3 19 (10.6%) 165 (13.9%) 1504 (12.9%)

4 19 (10.6%) 139 (11.7%) 1123 (9.6%)

5-6 36 (20%) 215 (18.1%) 1519 (13%)

7-9 32 (17.8%) 171 (14.4%) 1237 (10.6%)

10-14 27 (15%) 136 (11.4%) 919 (7.9%)

15 or more 14 (7.8%) 63 (5.3%) 894 (7.7%)

Total 180 1,191 11,686

Mean 6.96 (max 37) 5.71 (max 52) 5.72 (max 140) International Conference on Child Maltreatment, May 4-7, Calgary, AB

The OQ 45 • a 45-item self-report measure

• takes about five minutes to complete

• grade 6 reading level

• provides a total score, based on all 45 items, as well as three subscales: symptoms of distress, interpersonal relationships and social role functioning

• scores range from 0 – 180, with a clinical cut-off of 63



Clinically Meaningful Change • Requires a Reliable Change Index for the measure • Requires movement from a score in the dysfunctional range to a

score typical of a functional population (Kendall, Marrs-Garcia, Nath & Sheldrick, 1999)

• For the OQ 45.2 – The RCI is 14 – The clinical cut-off of 63 differentiates clients in the

dysfunctional range from those of a functional population • A 14 point change is a very high clinical standard to meet (very

unlikely to happen by chance) • Most clinicians are satisfied with a smaller point change in

outcome suggesting positive or negative movement


Four Categories of Change for the OQ

Category Definition

No Change the client’s score changes by less than 14 points in either direction

Deteriorated the client’s OQ score increases by 14 or more points

Improved (Reliably Changed)

the client’s OQ score decreases by 14 or more points OQ Score but does not pass below the clinical cut-off of 64

Recovered (Clinically Significant Change)

the client’s OQ score decreases by 14 or more points and passes below the cut-off score of 64.


Child Welfare Sample Outcome Data

N=182

First Session OQ

Last Session OQ

Change Score

Results

54.81 43.12 -11.69 t(181) = 7.22, p <.001*

r =2.4 (a large effect)


Outcome Data – All Cases

First Session OQ

Last Session OQ

Change Score

Results Effect Size (r )

Child Welfare (n= 180)

54.76 42.9 -11.86 t(179) = 7.19, p <.001*

r = .67*

Family Violence Counselling Cases (n=1191)

53.00 42.52 -10.48 t(1190) = 17.85, p <.001*

r = .72*

CCC Cases (n=11,686)

76.86 67.03 -9.83 t(11685) = 54.57, p <.001*

r = .73*


Outcome Data – FV Group Clients

First Session OQ

Last Session OQ

Change Score

Results Effect Size (r )

RC Men Group Unadjusted Scores (n=398)

38.39 31.69 -6.7 t(397) = 8.92, p <.001*

r = .84*

RC Men Group adjusted Scores (n=398)

79.91 69.37 -10.53 t(391) = 12.66, p <001*

r = .72*



0

20

40

60

80

100

120

140

160

First Last

Sco

re

Session Number

OQ 45.2 Total Score

Score

Cutoff Score


0

10

20

30

40

50

60

70

80

90

First Session Last Session

OQ Score

Session Number

OQ 45.2 Change in Score

CW

FV

General

Clinical Cut-off

OQ Categories of Change

Category Child

Welfare Cases

Family Violence

Cases

CCC Cases US Baseline

Study

Deteriorated 12 (8.4%) 72 (7.4%) 648 (7.6%) 8.2%

No Change 60 (42%) 469 (48.1%) 4055 (47.4%) 56%

Improved 50 (35%) 286 (29.3%) 1933 (22.6%) 20.9%

Recovered 21 (14.7%) 149 (15.3%) 1915 (22.4%) 14.1%

Total 143 976 8,551 6,072


Stage of Change at First Session

Stage of Change Child Welfare Cases


CCC Cases

Precontemplation 49 (27.2%) 458 (38.5%) 1052 (9%)

Contemplation 92 (51.1%) 429 (36%) 4490 (38.4%)

Contemplation/ Demoralized

3 (1.7%) 44 (3.7%) 789 (6.8%)

Preparation 16 (8.9%) 104 (8.7%) 2316 (19.8%)

Action High Relapse 9 (5%) 79 (6.6%) 1412 (12.1%)

Action Low Relapse 11 (6.1%) 77 (6.5%) 1627 (13.9%)

Total 182


Relationship between Stage of Change at the First Session and Final Outcome • An Anova was conducted to explore the relationship between the

URICA at the first session and the OQ scores at both the first and last sessions. • The analysis showed that the difference in mean OQ score among

URICA stage is statistically significant both at the first session, F(5, 174)=76.6, p <. 001* and at the last session, F(5, 174)=3.43, p <. 01

• There is a relationship between stage of change and outcome. • Post hoc tests suggest that: at pre-test, clients pre-contemplation or

preparation score significantly lower on the OQ at first session than those in contemplation or action high relapse stages (R=.42. a medium effect)

• At post test, those in action high relapse at pre-test scored higher on the OQ than those in the precontemplation or contemplation stages (R=.3, a small effect)


Conclusion

• The analysis indicates significant improvements, with an average change in OQ score of -11.69 from the first to the final session. These are strong change scores even though they don’t meet the RCI of 14 points. • In fact the effect size for the treatment was r = 2.4, a large effect size

(generally in therapy we strive for an effect size of .8)

• Given that the average first and final OQ scores were both below the clinical cut-off of 63, recommend using the Marlowe Crown Scale for social desirability for future research to adjust scores for social desirability


Contact Information:

[email protected]

www.calgarycounselling.com


mailto:[email protected]

Documents

Child Welfare Outcomes in Counselling Practice€¦ · Child Welfare Outcomes in Counselling Practice Dr. Robbie Babins-Wagner, RSW CEO, Calgary Counselling Centre Adjunct Professor,