Evidence Based PracticeChild Welfare System

Webcast Training

September 15, 2005

Presented by

California Institute for Mental Health

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Main Points

Defining evidence-based practicesChild welfare outcomesChild welfare specific practices

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Nurse Family Partnership

Registered nurseIntensive 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

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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

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Parent-Child Interaction Therapy

TherapistsClinic with two-way mirror, and “bug in the

ear” technologyIndividual sessions (about 12)Home models being developedParent-child guided intervention

Relationship Discipline

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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

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Functional Family Therapy

Practitioners with diverse educational backgrounds

Individual family sessions (about 12-14)Standard process with content tailored to

individual familiesMultiple phases

Engagement Change behavior Generalization

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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

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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