Use of Evidence Based ProgramsDepartment of Social and Health Services

Engaging,

Motivating,

Assessing, and

Working Successfully

..... with Children and Families

Dana Phelps, M.Ed.

Evidence-based is defined in Evidence-based is defined in Washington as:Washington as:

ModelsModels that have that have..strong ..strong science/research supportscience/research support

ModelsModels that have.. that have.. been been

replicated (done) in several placesreplicated (done) in several places

Best practice?Best practice?

Best practice is a term that usually refers to common or acceptable Best practice is a term that usually refers to common or acceptable practice. practice.

For example accreditation standardsFor example accreditation standards

Best practices usually have shown some outcomes, but may not have Best practices usually have shown some outcomes, but may not have undergone a “study and control group” design studyundergone a “study and control group” design study

Best practices will always have a place in practice because:Best practices will always have a place in practice because:Not everything will be researchedNot everything will be researchedThere is no program that meets every child’s needsThere is no program that meets every child’s needsNot every child welfare activity can be measuredNot every child welfare activity can be measured

Do we have to study a program before we Do we have to study a program before we use it?use it?

Not necessarily. There are some child welfare areas Not necessarily. There are some child welfare areas where little or no research has been donewhere little or no research has been done

Promising practices may be implemented and studied as Promising practices may be implemented and studied as they are being usedthey are being used

It makes sense to use evidence based programs when It makes sense to use evidence based programs when they already exist for a group of children. When an EBP they already exist for a group of children. When an EBP does not exist, then a promising program may be useddoes not exist, then a promising program may be used

Programs in WashingtonPrograms in Washington

Multidimensional Treatment Foster Care (MTFC)Multidimensional Treatment Foster Care (MTFC)

Functional Family Therapy (FFT)Functional Family Therapy (FFT)

Parent Child Interaction Therapy (PCIT)Parent Child Interaction Therapy (PCIT)

Promoting First RelationshipsPromoting First Relationships

Incredible Years Program Incredible Years Program

Nurse Family PartnershipNurse Family Partnership

HomebuildersHomebuilders

Parent Child Interaction Therapy

• treatment for parents and young children (ages 2-7) • emphasizes improving the parent-child relationship and changing parent-child interaction patterns

In PCIT, parents are taught specific skills to establish a nurturing and secure relationship with their child and methods of appropriate discipline. PCIT is provided to a parent and child pair over approximately 20 weeks.

Parents are required to practice the new skills at home with their child.

Parent Child Interaction Therapy

PRIDE Skills

Praise appropriate behavior. - Use labeled praises.

Reflect appropriate talk - This is the skill that gets kids to talk!

Imitate appropriate play - Depending on your child, you may imitate exactly or with similarity

Describe appropriate behavior. - States what the child is doing right.

Enthusiasm

Homebuilders

An Intensive Family Preservation Services program designed to prevent out of home placement of children.

Utilized when a family has been referred for child abuse and neglect and the child or children are at imminent risk of placement.

Program is short in duration, usually 4 to 6 weeks. (40 hours of service average in those 4 – 6 weeks)

Homebuilders therapists respond to families 24 hours a day, 7 days a week.

Homebuilders

The program focuses on teaching parents to care effectively for their children by increasing the parents ability to:

• manage child behavior• utilize appropriate discipline,• provide a safe and nurturing home environment

Therapists have a low caseload (two cases at a time)

Functional Family TherapyFunctional Family Therapy

• Research-based Research-based prevention and intervention program for prevention and intervention program for adolescents and their familiesadolescents and their families

• TargetsTargets youth between 11-18…. youth between 11-18….

• Short-term, family-basedShort-term, family-based program program

• Average of 12 sessions over 4 monthsAverage of 12 sessions over 4 months

• Range of adolescent problemsRange of adolescent problems• drug abuse/use, conduct disorder,drug abuse/use, conduct disorder, family conflict family conflict

FFT Family-based philosophy...FFT Family-based philosophy...• We know families can be….We know families can be….

– discourageddiscouraged– hopelesshopeless– emotionalemotional– blamingblaming– less than motivatedless than motivated

• Our job…meet them where they are…Our job…meet them where they are…• We understand all families are We understand all families are uniquely organizeduniquely organized

– each a different and complicated social systemseach a different and complicated social systems

• We know all families have We know all families have strengths and resourcesstrengths and resources that we can tapthat we can tap

• Family is the “client”Family is the “client”

Guiding PrinciplesGuiding Principles

Obtainable but lasting changeObtainable but lasting changeThe The outcomeoutcome goals of therapy are those that are goals of therapy are those that are

obtainable and lastingobtainable and lasting– not someone’s idea of healthy families but……..not someone’s idea of healthy families but……..– obtainable behavioral changesobtainable behavioral changes

...are those that are:...are those that are:• obtainable behavioral changes …obtainable behavioral changes …• for these people …for these people …• with these resources …with these resources …• and these value systems …and these value systems …• in this contextin this context

FFT shows several important outcomes when used in FFT shows several important outcomes when used in child welfare settings:child welfare settings:

– a reduction in negativity within the familya reduction in negativity within the family

– improved communication in the familyimproved communication in the family

– increased parental supervisionincreased parental supervision

– reduced placement in foster care (FPS)reduced placement in foster care (FPS)

11% foster placement in FFT vs. 49% foster placement in services as 11% foster placement in FFT vs. 49% foster placement in services as usualusual

Trauma Focused CBT

• treatment for children (ages 5 -18) • emphasizes skills to cope with past trauma

TF – CBT teaches children in an individual setting ways of coping with past traumatic experiences and new skills. Caregivers of the children participate in some sessions where they learn to support the child.

This treatment is appropriate for children with “internalizing” behaviors and is not appropriate for children who are “acting out.”

Trauma Focused CBT ComponentsTrauma Focused CBT Components

• Psycho-education Psycho-education • Emotion regulation skillsEmotion regulation skills• Correcting maladaptive cognitionsCorrecting maladaptive cognitions• Desensitization/trauma narrativeDesensitization/trauma narrative• Interpersonal skillsInterpersonal skills• Positive parent management Positive parent management

Thoughts

Behavior Feelings

CBT TriangleCBT Triangle

Emotion Regulation SkillsEmotion Regulation Skills

““Helping children manage negative emotionsHelping children manage negative emotions””Targets: fear, anxiety, depression, angerTargets: fear, anxiety, depression, anger

Strategies:Strategies:– Feelings identificationFeelings identification– RelaxationRelaxation– Controlled breathingControlled breathing– Cognitive copingCognitive coping– SITSIT– Take a breakTake a break– MindfulnessMindfulness

Incredible Years Program

• treatment for parents of young children (ages 2-7) • emphasizes improving the parenting skills and use of appropriate discipline

Incredible Years teaches groups of parents specific skills to use in parenting their child and methods of appropriate discipline. The Incredible Years program groups will last between 12 and 16 weeks.

Parents are given homework to practice at home with their child.

Multidimensional Treatment Foster CareMultidimensional Treatment Foster Care

Program that serves children in a specially trained foster home

Only one foster child per home

Foster home is supported by a case manager that is available 24/7

Foster parents create a behavior management plan with the case manager

Multidimensional Treatment Foster CareMultidimensional Treatment Foster Care

The foster parents provide consistent rewards for positive behavior

Privileges are gained by the child for following the program

Foster child’s time heavily structured

Multidimensional Treatment Foster CareMultidimensional Treatment Foster Care

Child is awarded points for following rules and directions

Child loses points for “problem” behavior

Child usually has an individual therapist

Child’s “family” has a family therapist

Multidimensional Treatment Foster CareMultidimensional Treatment Foster CareOutcomesOutcomes

MTFC shows three important outcomes for the child welfare population:

• fewer placement disruptions• a decrease in rate of problem behavior • a 90% retention rate of foster families

Multisystemic Therapy (MST)

• treatment for families with adolescents• teach parents skills and connect them to resources needed to independently address the difficulties of raising teenagers

A focus is placed on helping youth and families cope with family, peer, school, and neighborhood problems. Within a context of support and skill building, the therapist places developmentally appropriate demands on the adolescent and family for responsible behavior. Intervention strategies are integrated into a social ecological context and include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavior therapies.

Multisystemic Therapy (MST)

The program is designed as an alternative to placing children out of home.

The therapist carries a caseload between 5 and 7 families and is available to the family 24/7.

The interventions primary goal is to reduce the need for out of home placement. It has successfully reduced the number of days in psychiatric hospitalization by 72% as compared to a treatment as usual program.

An MST adaptation for treatment of families of younger children is currently being studied for application in child welfare cases.

Programs being looked at:Programs being looked at:

Family Integrated Transitions (FIT)Family Integrated Transitions (FIT)Outcomes for co-occurring mental health and Outcomes for co-occurring mental health and

substance abusesubstance abuse

Project Safe CareProject Safe CareHome visiting program that focuses on parent and Home visiting program that focuses on parent and child bonding and infant/child health carechild bonding and infant/child health care

What about when there is no research?What about when there is no research?

At times, best practices are the only thing available to At times, best practices are the only thing available to guide practiceguide practice

When developing a new practice, evidence based When developing a new practice, evidence based programs can provide a foundation for building a program programs can provide a foundation for building a program or practice (i.e. skills that are effective with a group of or practice (i.e. skills that are effective with a group of people)people)

We can work with model developers and experts in the We can work with model developers and experts in the field to build the new practice or programfield to build the new practice or program

What are the limits?What are the limits?

No one program has yet been found to solve all the problems faced by children

There is not enough research on minority populations to know that every program works with every population

Successful use of evidence based programs depends on having skilled providers and support from the community

Where to get more informationWhere to get more information

The Washington State Institute for Public Policy recently published a report.

http://www.wsipp.wa.gov/pub.asp?docid=08-07-3901

Other state’s are doing similar work. Information on California’s efforts can be found at:

http://www.cachildwelfareclearinghouse.org                

QuestionsQuestions

For more information contact:Dana Phelps(360) 902-7653