Delaware's BEST Logic Model

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Acknowledgements

The development of this logic model and the corresponding data was a collaborative effort involving many partners and stakeholders including the BEST grant team and the evaluation committee. In particular the following individuals were instrumental: Marissa Smith Timothy Fowles Cathy Imburgia Mary Moor

Delaware’s B.E.S.T.

for Young Children and Their Families

Logic Model & Outcomes

Delaware Children’s DepartmentDivision of Prevention and Behavioral Health

Services

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Delaware’s B.E.S.T. for Young Children and Their FamiliesDelaware Children’s Department | Division of Prevention and Behavioral Health Services

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Families

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Providers

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B.E.S.T. Team

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System of CareAgencies,

Organizations, Stakeholders

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System of CareBroader

Community

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System of CareLimits of System

(e.g., Geography, Resources)

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Evaluation Outcomes

Providers

Children and Families

Agencies, Organizations, Stakeholders

Broader Community

Evaluation Outcomes

Providers

Broader Community

Satisfaction with Trainings | Adoption of Evidence-Based Practice| Fidelity to ModelBurnout

Evaluation Outcomes

Providers

Children and Families Broader Community

Strong & Representative Family Organization | Awareness of Child MH Issues & ResourcesStigma

Evaluation Outcomes

Providers

Broader Community

Funding & Resources for Child Mental Health | Publicity | Access to ServicesUnnecessary Duplication of Services | Systemic Barriers

Evaluation Outcomes

Providers

Broader Community

PreBERS: Family Involvement

Homework Compliance

Child and Family Outcomes

• Observational Coding Measure• Completed by therapist during session• Caregiver Interaction Skills• Positive “Do” Skills• Reflections, Labeled Praise,

Behavioral Descriptions• Negative “Avoid” Skills• Commands, Questions, Negative Talk

Homework Compliance

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170123456789

PositiveNegative

Session Number

Combined Home-based and Outpatient Sessions up to 8/1/2012; N Sessions = 2149

• Parent report of completed homework collected at every session• Number of days completed HW• Possible number of days to

complete HW

Child and Family OutcomesDPICS

Homework Compliance

(HW compliance graph here)

Homework Compliance

• Parent-report measure• 42 items + 7 open-ended questions• Identifies a child’s:• Strengths• Emotion regulation• School readiness• Language and attention skills• Social confidence

Homework Compliance

(PreBERS graph here)

Homework Compliance

DECA: Self Regulation

DECA: Self-Control

DECA: Attachment

DECA: Initiative

PreBERS:Emotion Regulation

PreBERS: Social Confidence

• Parent-report measure• Three versions:

• DECA 1–18M (33 items, 5 minutes)• DECA 18–36M (36 items, 5 minutes)• DECA 2–5Y (37 items, 5 minutes)

• Assesses:• Protective factors• Initiative• Self-regulation• Attachment/relationships• Self-control

DECA: Self-Control

DECA: Attachment

DECA: Initiative

41.06 40.83

*Graph shows t-scores

Clinical concern

p <.05 n.s.

N = 41 N = 31 N = 18

DECA: Self-Control

DECA: Attachment

DECA: Initiative

DECA: Self-Control

DECA: Attachment

DECA: Initiative

Baseline 6 Month Follow-up 12 Month Follow-up20

43.06 42

Clinical concern

p <.05 n.s.

*Graph shows t-scores

DECA: Self-Control

DECA: Attachment

DECA: Initiative

DECA: Self-Control

DECA: Attachment

DECA: Initiative

• Graph here

DECA: Self-Control

DECA: Attachment

DECA: Initiative

DECA: Self-Control

DECA: Attachment

DECA: Initiative

• Graph here

DECA: Self-Control

DECA: Attachment

DECA: Initiative

Child and Family Outcomes• Parent-report measure• 42 items + 7 open-ended questions• Identifies a child’s:• Strengths• Emotion regulation• School readiness• Language and attention skills• Social confidence

DECA: Self-Control

DECA: Attachment

DECA: Initiative

• (Graph here)

DECA: Self-Control

DECA: Attachment

DECA: Initiative

DECA: Self-Control

DECA: Attachment

DECA: Initiative

• (Graph here)

DECA: Self-Control

DECA: Attachment

DECA: Initiative

EQ-R2: Academic Performance

EQ-R2: Achievement

PreBERS: School Readiness

EQ-R2: Achievement

• (Graph here)

EQ-R2: Achievement

• Parent-report measure• 15 questions with subparts• Assesses child’s functioning in school• Topics covered:• School attendance/grade level• Special placements and plans• School achievement• Disciplinary actions

EQ-R2: Achievement

• (Graph here)

EQ-R2: Achievement

Child and Family Outcomes• Parent-report measure• 15 questions with subparts• Assesses child’s functioning in school• Topics covered:• School attendance/grade level• Special placements and plans• School achievement• Disciplinary actions

EQ-R2: Achievement

• (Graph here)

EQ-R2: Achievement

CCSP-R: Cultural Competence

Multi-Sector Service Contacts

Youth Services Survey: Families

• Parent-report measure• 27 items• Measures perceptions of service across

five domains:• Access• Participation in treatment• Cultural sensitivity• Satisfaction• Outcomes

Participation in Tx

Access to Services

Cultural Sensitivity

Satisfaction

Child and Family OutcomesYouth Services

Survey: Families

• Access to services graph here

Participation in Tx

Access to Services

Satisfaction

• Participation in Tx graph here

Participation in Tx

Access to Services

Satisfaction

• Cultural sensitivity graph here

Participation in Tx

Access to Services

Satisfaction

• Satisfaction w/ services graph here

Participation in Tx

Access to Services

Satisfaction

• Parent-report measure• 47 items with subparts• Report of child and family service use:• Services used• Service locations and convenience• Quantity of services received• Satisfaction with services• Payments for services

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Services received graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Location graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Quantity graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Satisfaction graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Continuity in care graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Length of tx graph here

Convenient Location

Services Received

Quantity Received

Satisfaction

Length of Treatment

Continuity in Care

• Parent-report measure (no staff as caregiver version)

• 13 items• Assesses:• Importance of culture in the lives of the

respondent• Caregiver’s perspective on provider’s

consideration of family’s beliefs, traditions, and practices when providing services

• CCSP-R Graph here

National Evaluation

6 months

12 months

18 months

24 months

Grand total

Average of DE Reten-tion (%)Average of National Retention (%)

National Evaluation

Although this is considered a key outcome, no data currently are available.

Expulsions

Suspensions

Child and Family Outcomes• Parent-report measure• 15 questions with subparts• Assesses child’s functioning in school• Topics covered:• School attendance/grade level• Special placements and plans• School achievement• Disciplinary actions

• Suspensions graph here

Child and Family OutcomesEQ-R2

Expulsions

Suspensions

• Expulsions graph here

Child and Family OutcomesEQ-R2

Expulsions

Suspensions

Parenting Stress Index (PSI)

Caregiver Strain Questionnaire

• Parent-report measure (no staff version)

• 21 items• Assesses difficulties, strains, and

other negative effects related to caring for a child with emotional and behavioral problems

• CGSQ graph here

• Parent-report measure (no staff version)• 36 items• Assesses:• Level of parental distress• Parent-child dysfunctional interaction• Difficult child characteristics

CG-Child Interax

Parental Distress

Difficult Child

• Graph: PSI Parental distress here

CG-Child Interax

Parental Distress

Difficult Child

• Graph: Dysfunctional Parent-Child Interactions here

CG-Child Interax

Parental Distress

Difficult Child

• Graph: PSI Difficult Child here

CG-Child Interax

Parental Distress

Difficult Child

Child Behavior Checklist (CBCL)

Problem

Intensity • Parent-report measure of child disruptive behavior• Intensity score• Problem score

• 36 items• Completed at every PCIT session

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1790

Intensity

Session Number

Range of Significant Concern

Combined Home-based and Outpatient Sessions up to 8/1/2012; N Sessions = 2149

Problem

Intensity

There was a significant decrease in ECBI Problem scores, β10 = -.56 (SE = 0.09), p < .001, and this change was not statistically different between treatment groups, β11 = -.04 (SE = 0.13), p = .76.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 205.00

Outpatient

Home Based

Clinically significant

Problem

Intensity

• Standardized measure of children’s symptomatology• Caregivers’ report of their child’s problems,

disabilities, and strengths• Caregivers say how often statements describing

behaviors are true for their child• 17 social competence items, 113 behavior problem

items• Requires approximately 20 minutes to complete• Yields result scales in three areas:

• Syndrome Scales• DSM-Oriented Scales• Externalizing, Internalizing, and Total Problems

scales

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

Baseline 6 Month Follow-up 12 Month Follow-up60

p <.05

N = 54 N = 31 N = 18

Clinically significant

Child Behavior Checklist 1.5-5 (CBCL 1.5-5): Aggressive Behavior subscale (t-

scores)

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

Child Behavior Checklist 1.5-5 (CBCL 1.5-5): Attention Problems subscale (t-scores)

• Graph: Attn Prblms here

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

Child Behavior Checklist 1.5-5 (CBCL 1.5-5): Externalizing subscale (t-scores)

• Graph: Externalizing here

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

Child Behavior Checklist 1.5-5 (CBCL 1.5-5): ADHD Problems subscale (t-scores)

• Graph: ADHD Problems here

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

Child Behavior Checklist 1.5-5 (CBCL 1.5-5): Oppositional Defiant subscale (t-scores)

• Graph: Oppositional Defiant Problems here

Attention Problems

Aggressive Behavior

Externalizing

ADHD Problems

ODD Problems

By Completion Status

Child and Family Outcomes: Attrition

Not Engaged Dropout CDI Dropout PDI Completer

26%13%

Outpatient CSM

c2 (3, N = 169) = 21.20, p < .001

By Completion Status

Comparison to Other Trainings

Overall Training Satisfaction

Provider Outcomes

• Therapists were surveyed following completion of a 40-hour PCIT training

Provider Outcomes

Trainer Didactics Family Sessions

Videos Role-Play Manuals123456789

Post-Training

Dissatisfied

Satisfied

Provider Outcomes

• Therapists were asked to rate how their experience with the 40-hour PCIT training compared to their experience with previous trainings

Provider Outcomes

Much Better67%

Better22%

Neutral11%

Post-Training

None indicated “Worse” or “Much Worse”

Provider Outcomes

CSM Service Location

Provider Outcomes

CSM Service Location

Provider Outcomes

Interactive CSM Client Map

Provider Outcomes

Community Outcomes

Curriculum Evaluation

Pre-Awareness Week Knowledge

Location of Awareness Program

• Families who attended Mental Health Awareness Week completed an online survey responding to the following items

Community OutcomesLocation of

Awareness Program

Sussex County (3)

Kent County (6)

New Castle County (25)

Community OutcomesLocation of

Awareness Program

Awareness Week

Prior Participation

• Individuals responded to the following items keeping in mind how they felt before participating in Children’s Mental Health Awareness Week

Community Outcomes

Awareness Week

I knew that Awareness Week existed

Strongly Disagree (9)Disagree (10)Neither Agree nor Disagree (5)Agree (9)Strongly Agree (4)

Prior Participation

Community Outcomes

Awareness Week

I knew that Delaware's BEST for Young Children existed

Prior Participation

Community Outcomes

Awareness Week

I have participated in Awareness activities before

Prior Participation

Community Outcomes

Usefulness of Materials

Families’ Opinions

Children’s Opinions

Easy to Understand

• Individuals responded to the following items keeping in mind how they felt about the program curriculum

Community Outcomes

The curriculum materials were useful

Neither Agree nor Disagree (1)

Agree (18)

Strongly Agree (18)

*None responded ‘Strongly Disagree’ or ‘Disagree”

Easy to Understand

Community Outcomes

I understood how to use the curriculum ma-terials

Disagree (1)Neither Agree nor Disagree (0)Agree (19)Strongly Agree (19)

*None responded ‘Strongly Disagree’

Easy to Understand

Community Outcomes

The families liked the curriculum

Neither Agree nor Disagree (15)Agree (15)Strongly Agree (7)

Easy to Understand

Community Outcomes

The children liked the curriculum

Neither Agree nor Disagree (4)Agree (15)Strongly Agree (19)

Easy to Understand

Community Outcomes

Agency Outcomes

MSSC-R

Agency Outcomes

• Parent-report measure• 47 items with subparts• Report of child and family service use:• Services used• Service locations and convenience• Quantity of services received• Satisfaction with services• Payments for services

**Listed in Child and Family Outcomes section

MSSC-R

Agency Outcomes

• Graph hereMSSC-R

The “Logic”

Population/Context

OutcomesServices

Families

Providers

Logic Model

OutcomesServices

Agencies

OutcomesServices

One person’s service is another’s outcome…

Families

Providers

Logic Model

OutcomesServices

Agencies

OutcomesServices

One person’s service is another’s outcome…

Contact Us:

Tim FowlesDepartment of

PsychologyUniversity of

Delaware108 Wolf HallNewark, DE 19702tfowles@udel.edu(302) 781-3213

Delaware’s B.E.S.T.261 Chapman Rd.Newark, DE 19702Mary.Moor@state.de.usMain: (302) 781-

Delaware's BEST Logic Model

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