Example of Evidence-based practice process The Center for Safe and healthy families Lindsay Shepard, MSW, MSc

Objective To overview an example of Evidence-Based Practice and what we will be studying step by step this semester.

The Agency The Center for Safe and Healthy Families Population: PCMC outpatient Salt Lake City, UT Population: Children/Families who have experienced child maltreatment Mission: “address child maltreatment through medical assessment, mental health treatment, education, and research”

The agency Therapy Team: Client Needs: 2 LCSWs 2 Clinical Psychologists 1 LPC 2-3 Student Interns Client Needs: Trauma Disruptive behavior Attachment/reunification Mild/moderate sexual behavior problems (12 and under) Predominant Treatment Modalities: TF-CBT PCIT

The client Sabrina - client Maggie – mother 8 years old/Caucasian/female In-tact family/second of four children Second grade in charter school Identifies as LDS Presents spacy and aloof Maggie – mother Early 30s Presents burnt out and mildly indifferent

The problem(S) Pervasive self-stimulating behavior (“the trance”) Identified since age 2 No disclosed experience/exposure to sexual abuse Estimated 15-20 times/day at school Poor social/personal boundaries Rubs arms/touches hair/kisses cheeks of peers Insecure parent-child relationship “Sabrina’s mom indicated feeling distant, disconnected, or insecure in her relationship with and parenting of Sabrina.”

Assessment & Diagnosis Assessment Tools: Clinical interview The Behavioral Assessment System for Children(BASC) The Child Sexual Behavior Inventory (CSBI) The Parenting Relationship Questionnaire (PRQ) Diagnosis: Axis I: 300.00 Anxiety Disorder NOS (Primary) v61.20 Parent-Child Relational Problem (Secondary) Axis II: None Axis III: None Axis IV: Some inattention/externalizing behaviors, symptoms of anxiety, pervasive self-stimulating behavior, poor boundaries and social skills, parent-child relational problems Axis V: Current GAF of 55

Now what?! Discussion Question: What would you do?

But that probably won’t work…right?! So…Use Evidence Based Practice?

Step 1: Pose a Question What are the most effective interventions for treating child sexual behavior problems? PICO: Problem: sexual behavior Population: child Intervention: ? Comparison: ? Outcome: decrease sexual behavior

Step 2: Search the literature

Step 3: Assess evidence/options Meta-analysis (11 included studies & 18 treatments) The overall treatment effect size was estimated at 0.46 Identified effective elements: Parent Behavior management skills Rules about sexual behavior Sex education Abuse prevention Child Self-control skills Overall Family involvement Strong meta-analysis, but included studies have small, predominantly trauma-exposed samples and highly variable outcomes .2 small .5 medium .8 large Who is the primary agent of change? (St. Amand, Bard, & Silovsky, 2008)

Step 4: Select treatment with client(s) and implement Child Components Psychoeducation about sexual behavior rules Age-appropriate sex education Boundaries and social skills Emotional regulation, impulse control, and coping/relaxation skills Safety skills Parent Components Psychoeducation and skills Family rules/practices regarding sexual behavior Increased monitoring and supervision Behavioral management skills Coordination with other caregivers (e.g., teachers) Parent-Child Components Relationship improvement Positive interaction or special time (ATSA, 2006; St. Amand, Bard, & Silovsky, 2008)

Step 5: Evaluate client outcomes

Repeat or Celebrate! Repeat EBP process as needed OR terminate and

Comments? Questions?

READY?!?

In your Groups: Select an agency/program for your group’s semester projects AND Prepare a 1-2 paragraph introduction and summary of your selected agency, including, but not limited to, the following items: Name, location, and founding date Agency type (e.g., outpatient, day program, inpatient, etc.) and setting (e.g., community, hospital, etc.) Mission statement Target population Treatment team and resources Primary services Therapeutic models/interventions

Example agency description The Center for Safe and Healthy Families in Salt Lake City, Utah is a Primary Children’s Medical Center outpatient program predominantly treating children and families who have experienced trauma related to child maltreatment. The agency’s mission is to “address child maltreatment through medical assessment, mental health treatment, education, and research” (Center for Safe and Health Families Pamphlet, 2010). The therapy team is made up of 2 Licensed Clinical Social Workers (LCSWs), 2 Psychologists, 1 Licensed Professional Counselor (LPC), and 3-4 student interns. The Center for Safe and Healthy Families supports Evidence-Based Practice and makes a point of using and evaluating evidence-based trauma treatment practices, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Parent-Child Interaction Therapy (PCIT). As a means of supporting child sexual abuse prevention, the Center for Safe and Healthy Families often accepts young children (12 years and younger) with mild to moderate sexual behavior problems to treatment, as is the case with the following client.

References Association for the Treatment of Sexual Abusers (2006). Report of the task force on children with sexual behavior problems. ATSA, 1-32. Friedrich, W.N. (2007). Children with Sexual Behavior Problems: Family-Based Attachment-Focused Therapy. W.W. Norton & Company: New York, New York.  St. Amand, A., Bard, D.E., & Silovsky, J.F. (2008). Meta-analysis of treatment for child sexual behavior problems: Practice elements and outcomes. Child Maltreatment, 13, 145-166.