Applying Research on Risk & Resilience to Assessment of Children with Sexual Behaviour Problems

1. Applying Research on Risk& Resilience to Assessmentof Children with Sexual Behaviour Problems Jane F. Gilgun, Ph.D., LICSW Professor, School of Social Work, University of Minnesota, Twin Cities 1404 Gortner Avenue St Paul MN 55108 USA jgilgun@umn.edu http://ssw.che.umn.edu June 26, 2003 G-MAP Conference, Bolton, Lancashire, United Kingdom

2. Topics • Assessment 101 • The CASPARS • The 4-D • Case Studies • Customizing Tools

3. Significance • Practice effectiveness • Accountability • Brief treatment • Evidence-based practice • Best research evidence • Clinical experience • Client preferences, wants, cultures • Practitioners’ personal experiences, values, cultures • Ethical codes

4. Purposes of the Instruments • direct attention to positives • lead to helpful assessments • help formulate treatment plans • help estimate progress in treatment • provide a check on countertransference • provide measures of outcome • provide data that demonstrates effects of treatment

5. Concepts of the Instruments • Assets are Significant in Models of Risk • Adding Assets to Risk Models Increases Accuracy of Classification • Assets Alone in Models of Risks May be as Accurate as Risk Alone Models • Assets, Risks, and Protective Factors Reside Within Individuals, Families, Other Social Groups, Communities, Social Policies, and Cultural Themes and Practices. • Asset Models Require Shifts in Thinking

6. Assets • Assets are positive counterparts of risk that can contribute to pro-social outcomes when individuals are exposed to risks. • Assets include factors such as high IQ, physical attractiveness, verbal facility, parents who care, safe neighborhoods, adequate family income, a pro-social sense of agency, optimism about a positive future • Not all persons with assets turn out well, nor do all persons from poor families and unsafe neighborhoods have maladaptive outcomes

7. Risks • Risks predict that a proportion of an at-risk group will experience adverse outcomes. • Persons with risks are vulnerable to an associated outcome, but risks cannot predict that any one person in an at-risk group will experience that outcome • Risks include childhood maltreatment, unsafe neighborhoods, isolated families, exposure to persons who model violent behaviors, genetic risks such as those predisposing persons to particular types of physiological reactivity Individuals in an at-risk group, however, are vulnerable to that outcome.

8. Risk Pile-Up • a series of risks that may • overwhelm whatever resources an individual can marshall • or in some cases persons appear to have the resources to cope.

9. Protective Factors assets individuals actively use • to cope with • adapt to, or overcome vulnerability-inducing conditions, or risks

10. Protective Factors • Pro-social sense of agency • Desire to emulate persons who are pro-social • Have avenues open to them where they can attain a sense of self that includes self-efficacy and self-worth • These avenues do not harm self or others • Emotional expressiveness • Affirmative relationships • Healthy sexuality • Sense of belonging to a pro-social group • Strong sense of positive future • Resources to attain future goals

11. Resilience • Definition: positive outcomes when individuals have been exposed to risks • Resilience means a person has risk conditions and therefore has vulnerabilities • Persons can be • Resilient at one point and not at others • Resilient in some areas and not in others

12. CASPARS • Emotional expressiveness • Family Relationships • Peer Relationships • Family Embeddedness • Sexuality

13. Scoring the CASPARS • Each instrument yields two scores: An asset score and a risk score • Scores for each instrument are attained by summing each column • Children can be classified by using scores from single instruments • Children can be classified using scores resulting from the sums of scores of all the instruments for a global score

14. Scoring the CASPARS • 1=low strength or low risk • 2=medium strength or medium risk • 3=high strength or high risk • 0=not observed or unknown

15. The 4-D • Belonging • Mastery • Independence • Generosity

16. Scoring the 4-D • Each instrument yields two scores: An asset score and a risk score • Scores for each instrument are attained by summing each column • Children can be classified by using scores from single instruments • Children can be classified using scores resulting from the sums of scores of all the instruments for a global score

17. Scoring the 4-D • 1=mixed • 2=low strength or low risk • 3=medium strength or medium risk • 4=high strength or high risk

18. Assets Risks Relationship of Assets & Risks Over the Course of Intervention 40 30 20 10 0 T1 T2 T3

19. Clinical Assessment Tools • Short, easy to use • Useful to practice • Provide scores • Not the same as tools used in psychological and educational testing • Provide practice guidelines • When they are based on research & practice experience

20. Types of Assessments • Unsystematic • Systematic but idiosyncratic • Systematic and shared

21. Systematic, Shared Asessments • Can coordinate practice across cases, within agencies, and across agencies • Provide practice guidelines • Help standardize practice • Provide clear identity for the agency

22. Each Case is Unique • General, Agency-Wide Assessment • Individualized goals, outcomes, and interventions

23. The CASPARS: Sources of Concepts • My reflections on the factors associated with resilience • Factors extracted from • My long-term life history research (primary) • Integrated with • social work’s ecological perspectives • Research on risk and resilience

24. Sources of Items: 4-D • Circle of Courage • Related research and theory • Experience of social work professionals and one clinical psychologist • My life history research

25. Sources of Items: CASPARS • Primary: My life history research • Backed up with • Related research and theory • Experience of two social work professionals and two clinical psychologists

26. Stetson School Assessment • Responsibility • Honesty • Motivation for treatment • Remorse • Developed by Phil Rich, Barre, MA, USA • 1/978/355-4541

27. Capacities for Accountability • What do the young people say about their problematic sexual behaviours? • Can they describe them? • Take responsibility for them? • Recognize harm done? • Are they willing to apologize? • Are they willing to work on managing these behaviours? • This is a strengths-based approached because such questions are asking the young people to tap into their competencies.

28. Capacities for Accountability • Appropriate vs. flat affect in talking about their behaviours • Take responsibility vs. blame others • Remorse vs. “blowing off” • Signaled by • I’m sorry I hurt others. • I feel ashamed. Does the child appear to have these responses but need help in articulating them? • How can practitioners do assessments that provide children with a sense of safety so that children can show their deep shame, embarrassment, guilt, and remorse, which we can assume is almost always there?

29. Field Tests • CASPARS • 25 professionals • 1 state • N=146 • 4-D • 25 professionals • 4 states • N=118

30. The CASPARS • Content Validity • Item-Total Analysis • Coefficient Alpha • Inter-Rater Reliabilities • Construct Validities

31. Item-Total Analysis Means Emo Peer Fam Rel Fam Emb Sex .76 .63 .80 .78 .67 Note: none below .50

32. Alphas & IRR # Items Alphas IRR • Emo 14 .94 .92 • Peer 16 .90 .93 • FamRel 20 .97 .93 • Embed 13 .96 .92 • Sex 13 .90 .95

33. Construct Validities R • Emo -.56 • Peer -.80 • FamRel -.81 • Embed -.82 • Sex .46

34. The 4-D • Content Validity • Item-Total Analysis • Coefficient Alpha • Interviewing

35. Results of Item-Total Analysis Instrument # of Items # Below .5 Belonging 12 1 Mastery 18 2 Independence 9 1 Generosity 9 0

36. Results: Coefficient Alphas Initial Eliminate Final Belonging .87 Q8 .89 Knowing .93 Q2 & 2 .93 Independence .87 Q4 .91 Generosity .91 0 .91

37. Results: Standard Errors of Measurement Expected Actual Belonging 5.5 5.62 Mastery 9.5 7.16 Independence 4.0 8.84 Generosity 4.5 4.87 Total 11.94 11.75

38. Interviews with Users • Usefulness the most important criteria for the worth of practice tools • Find out instruments’ usefulness through discussions with users

39. Interviews with Users • Individually • Phone • Email • In-person • Group in-Person • Minnesota staff • South Carolina staff • Informational interviews in person • South Carolina social workers and care providers

40. Responses to the Field Test:Summary • Positive responses • Helped me know youth in a new way • Led to one of the best conversations I’ve ever had • Areas for improvement • Too long • Too intrusive, such as the questions on sexuality • Don’t fit practice

41. References Brendtro, Larry K., Martin Brokenleg, & Steven Van Bockern (1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Educational Service Gilgun, Jane F. (2003). The 4-D: Strengths-based instruments for the assessment of youth who’ve experienced adversities. Submitted for publication. Gilgun, Jane F. (2002a). Completing the Circle: American Indian Medicine Wheels and the promotion of resilience in children and youth in care. Journal of Human Behavior and the Social Environment, 6(2), 65-84. Gilgun, Jane F. (1999b). CASPARS: New tools for assessing client risks and strengths. Families in Society, 80, 450-459. tools available at ssw.che.umn.edu/faculty/jgilgun.htm Gilgun, Jane F., Susan Keskinen, Danette Jones Marti, & Kay Rice. (1999). Clinical applications of the CASPARS instruments: Boys who act out sexually. Families in Society, 80, 629-641. Levitt, J. L., & Reid, W., J. (1981). Rapid-assessment instruments for practice. Social Work Research and Abstracts, 17, 13-19. Schafer M. (1999) Nomothetic and idiographic methodology in psychiatry: A historical-philosophical analysis. Medicine, Health Care & Philosophy, 2(3):265-74.