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Preparing BSW students for prevention oriented generalist practice
with high-risk families
Kathleen Woehrle, MSW, PhDCouncil on Social Work Education, APM
Denver, Colorado October 18, 2015, 9-10 am Sheraton Denver Downtown Hotel Capitol, Tower Building
Learning Objectives
Participants will:• observe the results of a formative evaluation of a model child abuse/neglect prevention program with high risk families which reinforce the boundaries of practice for BSW social workers.
• identify the scope of practice and instructional needs for generalist/BSW social works who work in prevention oriented child welfare services.
• consider how the case study’s resulting BSW curriculum could be implemented in the participant’s home program.
Theoretical Orientation
• Multiple factors (e.g., demographic, socio-cultural) contribute to risk of child abuse and neglect.
(Larner, Stevenson, Behrman, 1998)
Identified protective factors can promote family resilience. (Counts, Buffington, Chang-Rios, Rasmussen, and Preacher, 2010)
• Participation in parent education programs can reduce risk of future child abuse and neglect.
(Lundahl, Nimer, Parsons, 2006)
Families Strengthening Families (FSF)
a child abuse and neglect prevention program for children and families classified as at high risk.
designed to reduce “risk,” based on research which indicated that high risk families often have multiple risk factors
Funded by: Michigan Children’s Trust Fund
Context: High risk families in High need community
Multiple- co-occurring risk factors: family history, housing, parenting style, parent concern, couple risk and child issues
Community High poverty and High Rate of Violence (Magnified and multiplied needs and limited resources)
Services
Individualized program planning On–Site Parent EducationIn home parenting skills trainingCoordinated community based support
Participants
• 163 Cases, 58 completed documents• 43 families headed by single parent• 56 families living below $10,000/year• 50% living in shared/shelter/homeless• 39 African American families• 50% had 3 or more children • 50% had not completed high school• 24/58 were CPS involved
Formative Program Evaluation
Ex-post facto researchDependent variable = program completionA-priori independent variable = Level of riskIdentified intervening constructs:
Parental StressFamily Protective Factors (Counts et al, 2010) Program Participation.
Data collectionStaff interviews (yr1)Case record reviews (yr2) Client surveys (completion, 3, 6, 12 month follow up).
Instrumentation
• Assessment of family risk – Agency Developed Criteria
• FRIENDS National Resource Center for Community-Based Child Abuse Prevention – Protective Factors Survey (PFS)
• Parental Stress Index Short Form published by PAR (Psychological Assessment resources, Inc. copyright)
Risk Factor % casesself-identified risk
% risk correlated with DHS Referral
Risk Category
Family History 50 38 Family History
Homelessness 24 10 Housing
Ambivalence 23 14 Parenting Style
Unrealistic Expectations 15 10
Harsh Punishment 13 12
Substance Abuse 32 20 Parent Risks
Isolation 46 29
Parental Condition 25 16
Teen Parent 18 8
Domestic Violence 14 7 Couple Risk
Incarcerated Parent 14 6
Child Illness 9 1 Child Risk
Child Handicap 5 1
Child Mental Health 33 21
Delinquency 17 11
Risk and Source of
Identification
# of Risk Factors # cases
0 3
1 9
2 19
3 70
4 23
5 16
6 5
7 2
8 1
9 3
10 0
11 0
12 0
13 014 1
Multiple Risk Factors
Workshop Task 1Emerging Themes
# of Risk Factors # cases
0 3
1 9
2 19
3 70
4 23
5 16
6 5
7 2
8 1
9 3
10 0
11 0
12 0
13 014 1
Multiple Risk Factors
Clients often have multiple, co-occurring and mutually influencing risks.
Risk Factor % casesself-identified risk
% risk correlated with DHS Referral
Risk Category
Family History 50 38 Family History
Homelessness 24 10 Housing
Ambivalence 23 14 Parenting Style
Unrealistic Expectations 15 10
Harsh Punishment 13 12
Substance Abuse 32 20 Parent Risks
Isolation 46 29
Parental Condition 25 16
Teen Parent 18 8
Domestic Violence 14 7 Couple Risk
Incarcerated Parent 14 6
Child Illness 9 1 Child Risk
Child Handicap 5 1
Child Mental Health 33 21
Delinquency 17 11
Risk and Source of
Identification
There are categories of risk to be considered: History, Housing, Parenting Style, Parent, Couple and Child Characteristics
Risk may not be readily recognized by Protective Services
Perception of Parenting Perception of Self Perception of ChildI often have the feeling that I cannot handle things very well.
I often have the feeling that I cannot handle things very well.
Sometimes I feel like my child doesn’t like me and doesn’t want to be close to me.
Since having these children, I feel like I am almost never able to do the things I like to do.
Since having these children, I feel like I am almost never able to do the things I like to do.
My child is not able to do as much as I expected.
I am not as interested in people as I used to be.
I am not as interested in people as I used to be.
My child gets upset easily for the smallest things.
I don’t enjoy things as I used to.(5=strongly disagree)
I don’t enjoy things as I used to.(5=strongly disagree)
There are some things that my child does that really bother me a lot.
There are some things that my child does that really bother me a lot.
There are some things that my child does that really bother me a lot.
My child turned out to be more of a problem than I expected.
My child turned out to be more of a problem than I expected.
My child turned out to be more of a problem than I expected.
R I S K F A C T O R S
Perception of Parenting Perception of Self Perception of ChildI often have the feeling that I cannot handle things very well.
I often have the feeling that I cannot handle things very well.
Sometimes I feel like my child doesn’t like me and doesn’t want to be close to me.
Since having these children, I feel like I am almost never able to do the things I like to do.
Since having these children, I feel like I am almost never able to do the things I like to do.
My child is not able to do as much as I expected.
I am not as interested in people as I used to be.
I am not as interested in people as I used to be.
My child gets upset easily for the smallest things.
I don’t enjoy things as I used to.(5=strongly disagree)
I don’t enjoy things as I used to.(5=strongly disagree)
There are some things that my child does that really bother me a lot.
There are some things that my child does that really bother me a lot.
There are some things that my child does that really bother me a lot.
My child turned out to be more of a problem than I expected.
My child turned out to be more of a problem than I expected.
My child turned out to be more of a problem than I expected.
R I S K F A C T O R S
Parents’ perceptions of the parenting role, the self and the child contribute to the context of risk.
Creating an opportunity for a parent to change specific attitudes about themselves, the role of parenting and the child can significantly reduce risk.
Program Completion – Risk Factors 30 day follow up
• 43% report problems continue • 30% report new problems have
emerged:• 25% Housing • 4% Transportation • 25% Mental Health• 7% Employment• 4% Domestic Violence• 10% New CPS Risk
60 day follow up
• 45% report new issues have emerged• 13% new housing issues• 9% new mental health issues
Program Completion – Risk Factors 30 day follow up
• 43% report problems continue • 30% report new problems have
emerged:• 25% Housing • 4% Transportation • 25% Mental Health• 7% Employment• 4% Domestic Violence• 10% New CPS Risk
60 day follow up
• 45% report new issues have emerged• 13% new housing issues• 9% new mental health issuesCompleting a program does not fundamentally change factors which
contribute to risk.
Resilience Factors
We talk about problems. If I had trouble finding a job, I would not know where to go for help.
When we argue, we listen to both sides of the story.
There are many times when I don’t know what to do as a parent.
We take time to listen to each other. I know how to help my child(ren) learn.
We pull together when things are stressful. I believe that my child(ren) misbehave just to upset me.
We are able to solve our problems. I praise my child(ren) when they behave well.
I have others who will listen when I need to talk about my problems.
I lose control when I discipline my child(ren).
When I am lonely, there are several people I can talk to. I am happy being with my child(ren).I have no idea of where to turn if my family needed food and/or housing.
My child(ren) and I are very close to each other.
I have no idea where I would go if I had trouble making ends meet.
I am able to soothe my child(ren) when they are upset.
If I had a crisis, there are others who I can talk to. I spend time with my child(ren) doing what they like to do.
Resilience Factors
We talk about problems. If I had trouble finding a job, I would not know where to go for help.
When we argue, we listen to both sides of the story.
There are many times when I don’t know what to do as a parent.
We take time to listen to each other. I know how to help my child(ren) learn.
We pull together when things are stressful. I believe that my child(ren) misbehave just to upset me.
We are able to solve our problems. I praise my child(ren) when they behave well.
I have others who will listen when I need to talk about my problems.
I lose control when I discipline my child(ren).
When I am lonely, there are several people I can talk to. I am happy being with my child(ren).I have no idea of where to turn if my family needed food and/or housing.
My child(ren) and I are very close to each other.
I have no idea where I would go if I had trouble making ends meet.
I am able to soothe my child(ren) when they are upset.
If I had a crisis, there are others who I can talk to. I spend time with my child(ren) doing what they like to do.
There are several attitudes which contribute to resilience.
Program Completion Resilience Factors
30 day follow up
• 28% spend more time with child• 7% offer more praise• 22% understand more child
development• 14% more self esteem• 29% more use of community resources• 7% use more rewards systems• 43% more skills in parenting• 14% more patience
60 day follow up
•25% spend more time with child
•67% more use of community resources
•18% mental health services•18% resources to meet basic needs
•81.5% parent differently now
Program Completion Resilience Factors
30 day follow up
• 28% spend more time with child• 7% offer more praise• 22% understand more child
development• 14% more self esteem• 29% more use of community resources• 7% use more rewards systems• 43% more skills in parenting• 14% more patience
60 day follow up
•25% spend more time with child
•67% more use of community resources
•18% mental health services•18% resources to meet basic needs
•81.5% parent differently now
Over time, strategies which contribute to resilience change.
Program Completion Sustained Progress by Goal
Goal % Initial # Weeks0-14
% Program End
% 30 day % 60 day
Finish FSF 100 96 12 3
Use Community Resources
100
median=4mode = 14
48 34 40
Improve Parenting 100
Median = 4Mode=0
51 15 20
Employability na Median = 010% 1+
5.7 0 4
Housing 23 Median=020% 3+
19 10 na
Mental Health 33 Median = 025% 1+
13.2 20 20
Education na Median = 015% 1+
11.5 0 4
Program Completion Sustained Progress by Goal
Goal % Initial # Weeks0-14
% Program End
% 30 day % 60 day
Finish FSF 100 96 12 3
Use Community Resources
100
median=4mode = 14
48 34 40
Improve Parenting 100
Median = 4Mode=0
51 15 20
Employability na Median = 010% 1+
5.7 0 4
Housing 23 Median=020% 3+
19 10 na
Mental Health 33 Median = 025% 1+
13.2 20 20
Education na Median = 015% 1+
11.5 0 4
There is variability in patterns of client participation leading to program completion.
Individuation of practice often creates different client goals and differences of outcome in program completion.
High Risk families in High Need communities often experience chronic problems which must have sustained support to maintain progress.
Risk Category Reporting new problems at
30 day
Using Resources at
60 dayFamily History na na
Housing na naParenting Style 10% 50%
Parent Risks 30% 20% Couple Risk 10% 23%
Child Risk 10% 40%
Research Results: Program Completion
Required Comprehensive family services
Sustained involvement Yet
Program completion was necessary but insufficient services to reduce risk.
Research Results: Reducing Risk
Reducing parental stressStrengthen resiliencyA strong social worker/client relationship
immediate responsivenessintense involvementsystemic interaction
Research Results: Reducing Risk
Reducing parental stressStrengthen resiliencyA strong social worker/client relationship
immediate responsivenessintense involvementsystemic interaction
Program Completion is a necessary yet insufficient factor in Risk Reduction
Systematic Interaction
50% of families directly interacted with members of the agency at least 12 of the 14 weeks of the program.
Systematic Interaction
50% of families directly interacted with members of the agency at least 12 of the 14 weeks of the program.
Planning for regular and sustained interactions.
Intensity of Interaction
50% of families participated in 6 or more group training sessions
50% had a home visit 10 or more weeks of the training session
50% of families had a face to face interaction 9 or more weeks of the program (9-25 face to face visits)
Intensity of Interaction
50% of families participated in 6 or more group training sessions
50% had a home visit 10 or more weeks of the training session
50% of families had a face to face interaction 9 or more weeks of the program (9-25 face to face visits)
Preparation for the magnitude and frequency of interaction.
Immediacy of Interaction50% of families were in contact with the case manager at least 11 weeks of the program.
50% of families received phone calls from the case manager at least 6 weeks during the program.
40% of the families received more than an average of one call per week (20% received 20-49 calls)
50% of families were contacted by phone with the trainer for 8 or more weeks of the training session
25% of families received a call from the trainer more than one phone contact each week (15-26 calls)
Immediacy of Interaction50% of families were in contact with the case manager at least 11 weeks of the program.
50% of families received phone calls from the case manager at least 6 weeks during the program.
40% of the families received more than an average of one call per week (20% received 20-49 calls)
50% of families were contacted by phone with the trainer for 8 or more weeks of the training session
25% of families received a call from the trainer more than one phone contact each week (15-26 calls)
Be prepared to respond quickly and frequently to client concerns.
Accept responsibility for maintaining communication and support.
Research Results: Impact on Social Workers
•Caregiver fatigue high risk clients and vulnerable children.
•Resilience despite unstable funding for sustainable social services
Research Results: Impact on Social Workers
•Caregiver fatigue high risk clients and vulnerable children.
•Resilience despite unstable funding for sustainable social services
Stress and burnout are magnified when working with high risk families.
There are limits to social workers power to influence clients or control context, so set the goal to be creating the opportunity rather than the outcome.
Particular attention to self care must be made when working in contexts that are unstable and/or quality of care is not sustainable.
Workshop Task 2Scope of Practice
Scope of Practice- Generalist
Administration of assessment checklists requiring interpretation
Monitor client’s compliance with program’s expectations
Advocacy for group/communities Pre-admission general assessment for mental health facilities
Advocacy for individual Program Intervention planning and evaluation
Case Management (for individual, family, couple, group)
Provide assistance regarding community resources
Child or adult custody determination Provide information about available services
Child welfare case management Provide life-skills training
Community organization Provide linkages to community services
Conduct case-finding activities in community Psychosocial assessment
Identification of presenting problem Research – data collection
Impart general information and referral for assistance Teaching or education of client
Interventions with individuals, couples, families or groups to enhance or restore the capacity for social functioning
Focus of Curriculum
Community: Reducing parental stressClient: Strengthen resiliencyPractice: Relationship Self: Expectations and Resilience
Workshop Task 3Curriculum Review
BSW Curriculum Elements
Assess for Multiple Risk FactorsComprehensive Services
Relationship QualityProgram completion- Risk Reduction
Professional Self Care
Assessing for Multiple Risk FactorsObjectives Pedagogy Assessment
There are categories of risk to be considered: History, Housing, Parenting Style, Parent, Couple and Child Characteristics Risk may not be readily recognized by Protective Services
Clients often have multiple, co-occurring and mutually influencing risks
Parents’ perceptions of the parenting role, the self and the child contribute to the context of risk.
Comprehensive ServicesObjectives Pedagogy Assessment
Individuation of practice often creates different client goals and differences of outcome in program completion.Creating an opportunity for a parent to change specific attitudes about themselves, the role of parenting and the child can significantly reduce risk.Over time, strategies which contribute to resilience change.
Individuation of practice often creates different client goals and differences of outcome in program completion.
Relationship QualitiesObjectives Pedagogy Assessment
Immediate responsivenessBe prepared to respond quickly and frequently to client concerns. Be prepared to respond quickly and frequently to client concerns.
Intense involvementPreparation for the magnitude and frequency of interaction.
Systematic Interaction Planning for regular and sustained interactions.
There are several family behaviors which clients recognize as contributing to resilience.
Program Completion-Reducing RiskObjectives Pedagogy Assessment
There is variability in patterns of client participation leading to program completion. Completing a program does not fundamentally change factors which contribute to risk. High Risk families in High Need communities often experience chronic problems which must have sustained support to maintain progress.There is variability in patterns of client participation leading to program completion.
Professional Self-CareObjectives Pedagogy Assessment
High Risk families in High Need communities often experience chronic problems which must have sustained support to maintain progress.
Particular attention to self care must be made when working in contexts that are unstable and/or quality of care is not sustainable.
Program Completion is a necessary yet insufficient factor in Risk Reduction
There are limits to social workers power to influence clients or control context, so set the goal to be creating the opportunity rather than the outcome.
Stress and burnout are magnified when working with high risk families.
Stress and burnout are magnified when working with high risk families.
Planning for regular and sustained interactions.
Workshop Task 4 Take Away Message
Application To Your Institution Consider how you could adapt this model to your own program…
Would this model work in your program?What context considerations might there be? Are there known obstacles?What solutions could be offered to address the obstacles?
Emerging Realities of Child Abuse Prevention
NeedsMagnitude, Acuity, Longitudinal, Chronic, Cyclical, Repeated Impact on BSW
Generalist not advanced generalistUncertainty, Resilience
Specific instruction
THANK YOU !I invite you to email me at
https://cmich.academia.edu/KathleenWoehrle
