Using Research in Practice: The Benefits of Using Literature Reviews

to Guide the Peer Quality Case Review Process

Susan Brooks

Northern California Training Academy

August 2009

Why evidence matters The benefits of using research evidence in

practice How research can be used Factors that help & hinder evidence use Some examples of using research to inform

the Peer Quality Case Review Process

What we’ll look at…

*Material adapted from Module 1 of The Evidence Guide, Barnardo’s, 2006

Why make use of evidence?

Improve outcomes for service users & avoid investing in approaches that make no apparent difference

Improve accountability to stakeholders Increase objectivity and fairness in decision-making Increase confidence in and quality of decisions Develop good practice and increase the credibility of

services Develop more skilful and knowledgeable practitioners Question ourselves and our beliefs and have their worth

confirmed, or discard them as appropriate

By making research work better for services we can:

(The Evidence Guide, Barnardo’s, 2006)

Some questions for services

How are services planned? What information/evidence is used? How relevant and current is it? How do we know services ‘work’? Is it the best way? What are the alternatives?

(The Evidence Guide, Barnardo’s, 2006)

See: Macdonald (2001)

How can research be used?

To help decide whichinterventions or services to support

To illustrate ‘what works’

To make the reasons for decisionsabout services transparent.

To help staff understandthe needs of service users

To provide staff withnew and innovative practice ideas

To inform service users and carers of what the research says

Models of increasing research use

The research-based practitioner model Focus on professional education & training to develop practitioners'

skills in using research.

The embedded research model Evidence about 'what works' becomes embedded in

policies, guidelines and practice tools(Approach used in the Peer Quality Case Review Process)

The organisational excellence model Emphasis on developing a 'research-minded' culture within the

organisation.

SCIE Knowledge Review, Walter et al, 2004

Levels of Evidence

Effective-achieves child/family outcomes, based on controlled research (random assignment), with independent replication in usual care settings

Efficacious-achieves child/family outcomes, based on 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 (typically what is cited in child welfare research)

Emerging -recognizable as a distinct practice with “face” validity or common sense test

Clinical Expertise

Clinical State & Circumstances

Client Preferences and Actions

Research Evidence

Source: Shlonsky and Wagner, 2005

Using research to INFORM practices

Appropriate for this client?

Valid Assessment?

Effective Services

Contextual Assessment

Client Preference or Willing to

Try?

Cultural Barriers?

Overall Purpose of the Peer Quality Case Review

PQCR increases understanding of local practice

Informs SIP strategies– (Practice changes & system changes that support

changed practices)

Use literature reviews (the research) to better inform the practice of attaining understanding of local practices and SIP strategies

Example of using a literature for the Peer Quality Case Review

Factors, Characteristics, and Practices Related to Former Foster Youth and Independent Living

Programs: A Literature Review

Purpose of this Review:

Examine:• Factors related to experiences former foster youth face in

transitioning to independent living• Characteristics of Independent Living Programs (ILPs)• Factors related to successful transitions for former foster youth

Use this review to guide county Peer Quality Case Reviews (PQCRs)• Case Review Tools • Interview Tools

Background on Emancipating Foster Youth

Some of most vulnerable citizens in California due to higher rates of:

• High school drop outs• Homelessness• Criminal Involvement• Hospitalization for injury• Risk for mortality and morbidity• Dying from violence and accidents

(Barth, 1990; Piliavin, Wright, Mare, & Westerfelt, 1996; Sabotta & Davis, 1992; Widom, Ireland, & Glynn, 1995)

Routes for Exiting Foster Care

Majority exit when reunited with families, adopted, or emancipatedAlternate routes: running away, incarceration, entering psychiatric hospital, or death (Courtney & Barth, 1996)

10,363 foster youth ages 16-18 exited all types of care in California in 2008 (Needell et al., 2009)

Understanding the Transition to Exiting Foster Care

1st step: Examining conditions and characteristics that lead to each type of exit

• Factors associated with method of exiting foster care:• # of foster care spells (time between entry and exit)• # of weeks in foster care• Type of last placement

Understanding the Transition to Exiting Foster Care (continued)

High # of spells in foster care associated with unsuccessful exit

Youths who spend more time in foster care are more likely to be emancipated

Placement in group care associated with lower chance of emancipation

McCoy, McMillen & Spitznagel (2008):• Some youth discharged prematurely for arbitrary reasons and/or without

notice• Troubled youth (those with behavior problems, drug & alcohol

consumption), youth with multiple placements in last year, and youth with history of living on streets leave care earlier than other youth

• Study suggests most troubled youth need early services to prepare them for transition to independence or an Independent Living Program (ILP)

Independent Living ProgramsAssists current and former foster youth to become self-sufficient in transition out of foster care system (Foster Care Independence Act of 1999)

Those eligible:• Foster youth prior to day before

21st birthday• Foster youth in system between

their 16th and 19th birthday• Youth participated in Kinship

Guardianship Assistance Payment Program (Kin-GAP)

ILP services in CA:• Housing assistance• Employment assistance• Educational resources• Financial assistance with

college/vocational schools• Daily living skills• Money management• Decision making• Self esteem programs

Benefits of ILPs

ILP youth (vs. other foster care) in California:• More likely to receive information about

financial aid in high school• Significantly younger when beginning

college • Receive information on training

associated with independent living: opening bank account, obtaining care insurance, balancing checkbook, finding place to live

(Lemon, Hines, & Merdinger, 2005)

Factors Associated with Successful Transitions

Resilience factors for foster youth in transition to adulthood and independent living (Daining & DePanfilis, 2007):

Child Factors:• Gender: Females have higher rates of success than males• Age: Youth with an older age at exit have higher rates of success• Mental Health: Youth with lower levels of perceived stress have higher

rates of success• Relationships with Family: Higher levels of social support from friends

and family associated with greater resilience

Factors Associated with Successful Transitions (continued)

Mentoring Relationships:• 75% of former foster youth identified supportive, non-kin mentor – but 25% of youth

could not (Munson & McMillen, 2009)

• Having a mentor associated with fewer symptoms of depression, less perceived stress, and greater satisfaction with life 6 months later (Munson & McMillen, 2009)

• Support of long-term mentor associated with lower likelihood of being arrested and less perceived stress (Munson & McMillen, 2009)

• Researchers suggest mentors be included in service provision process – inform mentors about resources available to foster youth and provide funds to buy youth necessary instrumental items (Greeson & Bowen, 2008)

Factors Associated with Successful Transitions (continued)

Service/Program Factors:• Different outcomes for residential education (e.g. boarding schools) vs.

therapeutic residential treatment programs• Residential education programs place emphasis on education (Barth & Lee,

2009)

• 50% of youth enrolled in these schools enter college• 19% enter vocational program or military• 18% enter the workforce

• These programs provide lengths of stay that promote educational stability, encourage family involvement in youth’s education, and provide family-type environment with live-in house parents

• Viable alternative for foster youth facing instability in the system, but who are committed to education

ILPs and Youth Outcomes

Research suggests ILPs are beneficial for youth (Montgomery, Donkoh, & Underhill, 2005)Nearly all studies report higher rates of high school enrollment and completion, and vocational school or college attendanceMajority of studies report positive associations with employment outcomesAll studies reported generally favorable housing outcomes (e.g. living independently and paying own expenses)

Limited/Inconclusive research in associations between ILPs and homelessness, health outcomes, criminality, and self-sufficiency

Future Focuses for ILPs

Focus on access to stable housing

• Collaborations with local housing providers, local landlords, subsidized rent (Naccarato & DeLorenzo, 2008)

Focus on educational stability• Emphasize birth family

involvement in education throughout educational career

• High teacher and case worker’s expectations for achievement

• Connections between child welfare agencies and schools (Naccarato & DeLorenzo, 2008)

Future Focuses for ILPs (continued)

Focus on establishing/maintaining supportive relationships • Find suitable foster families for most troubled youth• Incorporate relationship building services into ILPs (e.g. relationship-

focused therapy) (Berscheid, 2003)

Focus on employment experiences• Emphasize vocational training and formal training programs that result in

employment• Collaborations between child welfare agencies and employers can promote

long-term, stable employment opportunities for former foster youth (Naccarato & DeLorenzo, 2008)

• California’s Regional Occupational Program offers variety of educational/job training services throughout local school districts with more than 100 occupational areas

Specific Recommendations for ILPs

1. Develop and provide ILPs tailored to needs of each youth with clear goals and outcomes

2. Provide aftercare services post-discharge, especially case management and crisis intervention

3. Collaborate with caregivers and other service providers responsible for youth

4. Develop and maintain sufficient housing programs5. Encourage youth to attend and complete college6. Do not set low expectations for foster youth7. Share information about effective ILP strategies and practices

amongst ILP coordinators

(Naccarato & DeLorenzo, 2008)

Promising Practices

Use of mentors and advocates!• Provide emotional and instrumental support• Advocate enrollment and continued participation in ILPs for youth• Provide a reliable network for assessing needs and services

Early introduction of ILP services• Youth need ILP services long before they are ready to emancipate• Most troubled youth likely to exit system unsuccessfully around the time

they become eligible for an ILP• ILP services should start as youth enter adolescence• Youth should be a part of the decision making process for their transition

Applications for the Construction of Case Review and Interview Tools

We know that…• Foster youth that are older have higher success rates than

those that exit the system at younger ages• Question: What services does our county offer to encourage

and promote youths’ willingness to stay in the system to meet eligibility requirements for ILPs?

• For a specific case review: What range of services did this child receive prior to exiting foster care?

Applications for the Construction of Case Review and Interview Tools

We know that…• Mentoring relationships are vital for youth both during and

after exiting foster care• Question: What type of advising/mentoring services does our

county provide for youth in the foster care system and upon entering into ILPs?

• For a specific case review: Was this child offered any opportunities for developing mentoring relationships?

Applications for the Construction of Case Review and Interview Tools

We know that…• Youth need ILP services long before they are

ready to emancipate Question: What type of services are foster youth provided and

when are they receiving them? For a specific case review: What services related to

independent living did this child receive and how long did the child have to wait before receiving such services?

Inform Focus Groups for PQCR

Who to include– Based on the literature,

Have a group of foster youth who recently emancipated Have a group of foster youth who are currently receiving ILP

services and have not emancipated If feasible include a group of youth participating in residential

education programs and therapeutic residential programs– Also include a group of staff who work in these two different

residential settings

Conclusion

Former foster youth are at a distinct disadvantage in early adulthood in the areas of education, housing, employment, economics, and health - BUT…

Research suggests ILPs positively contribute to youth outcomes in domains of education and employment

Focus on early enrollment in ILPs, fostering mentor relationships, and providing extended aftercare services!