Evidence Based Practice Child Welfare System

1. Evidence Based PracticeChild Welfare System Webcast Training September 15, 2005 Presented by California Institute for Mental Health

2. Main Points • Defining evidence-based practices • Child welfare outcomes • Child welfare specific practices Evidence Based Practices

3. Evidence-Based Practices • “…the integration of the best research evidence with clinical expertise and patient values” • Based on the definition used in “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001), by the Institute of Medicine Evidence Based Practices

4. Levels of Science • Effective--achieves outcomes, controlled research (random assignment), with independent replication in usual care settings. • Efficacious--achieves outcomes, 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, quasi-experimental, of success and/or expert consensus. • Emerging practice--recognizable as a distinct practice with “face” validity or common sense test. Evidence Based Practices

5. Child Welfare Outcomes • Protection from abuse and neglect • Children maintained safely at home • Families have enhanced capacity to provide for children’s needs • Permanency and stability without increasing foster care re-entry Evidence Based Practices

6. Child Welfare Evidence-Based Practices • Multidimensional treatment foster care • Early intervention foster care • Incredible years • Triple P parenting • Nurse family partnership • Parent-child interaction therapy • Functional family therapy • Trauma-Focused Cognitive Behavioral Therapy Evidence Based Practices

7. Multidimentional Treatment Foster Care (MTFC) • Effective • Teenage youth in or at-risk group home • Increases foster parent competencies • Decreases in child behavioral problems • Increases in parenting competencies • Low rate of re-entry into foster care or the juvenile justice system • Patti Chamberlain and colleagues from Oregon Social Learning Center • www.mtfc.com Evidence Based Practices

8. MTFC • Interdisciplinary team • One child per foster home • Intensive foster parent training • Foster parent support group and daily calls • Behavior point system in the foster home • Individual therapy for the youth • Behavior skills training for the youth • Family therapy for biological family • Coordination with school, family and others • 24 support to foster parent and biological family Evidence Based Practices

9. Early Intervention Foster Care • Promising--efficacious • Preschool age foster children • Increases foster parent competencies • Strong support for foster parents • Decrease in child behavior problems • Develops age appropriate child competencies • Improves parenting competencies • Decreases parental stress and depression • Increase in social support • Promotes reunification • Phil Fisher and colleagues from Oregon Social Learning Center • Pfisher@oslc.org Evidence Based Practices

10. Early Intervention Foster Care • Interdisciplinary team • Intensive foster parent training • Foster parent support groups • Daily support calls • 24 support to foster parent and biological family • Child focused therapy • Behavioral specialist for child in preschool, childcare or home settings • Parent training Evidence Based Practices

11. The Incredible Years • Effective • Children 2-12 • Decreases child behavior problems • Increases parenting competencies • Decreases maternal stress • Strengthens parent-teacher and parent-caregiver relationships • Carolyn Webster-Stratton, University of Washington • www.incredibleyears.org Evidence Based Practices

12. Incredible Years • Facilitated group intervention, practitioners with diverse educational backgrounds • Three sets of comprehensive developmentally based curriculums for parents, teachers and children to promote emotional and social competence • Basic parenting (early and school age) • Advanced parenting • Supporting your child’s education • Child social skills • Classroom based • Teacher training • Weekly groups (12-14 sessions), 2 hours in length • Uses work books, and video-vignettes to illustrate skills Evidence Based Practices

13. Triple P Parenting • Effective • Children 0-16 • Improves parenting skills • Decrease in parental stress and depression • Improves coping skills • Decrease in child behavior problems • Improves partner support • Improves parent anger management skills • Decreases social isolation • Matt Sanders, University of Queensland • www1.triplep.net Evidence Based Practices

14. Triple P Parenting • Practitioners with diverse educational backgrounds • Parenting program • Titrated levels of intervention • Detailed support material for parents • Five levels of intervention from primary prevention to treatment • Universal Triple P (primary prevention) • Selected Triple P • Primary Care Triple P • Standard Triple P (individual or group) • Enhanced Triple P Evidence Based Practices

15. Nurse Family Partnership • Effective • Low-income, high risk first time parents (pregnancy-age 2) • Intensive home visitation to promote health and welfare of parents and children • Improved pregnancy outcomes • Improved child health and well being • Increases economic self-sufficiency • David Olds and his colleagues, University of Colorado • www.nursefamilypartnership.org Evidence Based Practices

16. Nurse Family Partnership • Registered nurse • Intensive home visitation • Mother’s personal health • Quality of care • Life course outcomes • Visitations begin no later than 28 weeks of gestation until age 2 • Visits involve mother’s support system Evidence Based Practices

17. Parent-Child Interaction Therapy • Effective • Children ages 2-8 years • Parent-child guided intervention • Decrease child behavior problems • Increases parenting competencies • Sheila Eyberg and colleagues, University of Florida • www.pcit.org • http://www.ucdmc.ucdavis.edu/caare/mental/pcit_traincenter.html Evidence Based Practices

18. Parent-Child Interaction Therapy • Therapists • Clinic with two-way mirror, and “bug in the ear” technology • Individual sessions (about 12) • Home models being developed • Parent-child guided intervention • Relationship • Discipline Evidence Based Practices

19. Functional Family Therapy • Effective • Youth ages 11-18 years • Decreases family negativity and hostility • Decreases child behavior problems • Decreases the need for out of home placement • Increases parenting competencies • Jim Alexander and colleagues, University of Utah • www.fftinc.com Evidence Based Practices

20. Functional Family Therapy • Practitioners with diverse educational backgrounds • Individual family sessions (about 12-14) • Standard process with content tailored to individual families • Multiple phases • Engagement • Change behavior • Generalization Evidence Based Practices

21. Trauma-Focused Cognitive Behavioral Therapy • Effective • Children ages 4-18 years • Decreases PTSD symptoms • Decreases negative attributes (self-blame) about the traumatic event • Decreases externalizing problem behaviors • Improves parent-child relationship • Decreases parental depression • Improves parenting • Judith Cohen and Anthony Mannarino, Allegheny General Hospital • Jcohen1@wpahs.org or Amannari@wpahs.org Evidence Based Practices

22. Trauma-Focused Cognitive Behavioral Therapy • Therapists (LPHA) • Individual sessions (weekly) with the child, parent and joint child-parent (12-16 sessions) • Therapeutic relationship • Psycho-education • Emotional regulation • Stress management • Connecting thoughts, feelings and behaviors • Gradual in vivo exposure • Cognitive and affective processing of trauma experiences • Personal safety and skills training Evidence Based Practices