Use of Evidence Based Programs Department of Social and Health Services Engaging, Motivating, Assessing, and Working Successfully ..... with Children and Families Welcome -exciting program -only one of its kind in the country -combine didactic component with clinical supervision and practice in our clinic Who we are: -FFTinc -The Family Project Business details -Nancy details -meal questions at lunch -Rich/money Quick overview -Training side (this visit--others) planned to mimic the work you are doing with clients -on the supervision side….(client with us as you team/primary supervisor who will be the contact person Introductions: -who are you (experience/background/what want to learn) Dana Phelps, M.Ed. 1

Evidence-based is defined in Washington as: Models that have..strong science/research support Models that have.. been replicated (done) in several places

Best practice? Best practice is a term that usually refers to common or acceptable practice. For example accreditation standards Best practices usually have shown some outcomes, but may not have undergone a “study and control group” design study Best practices will always have a place in practice because: Not everything will be researched There is no program that meets every child’s needs Not every child welfare activity can be measured 34

Do we have to study a program before we use it? Not necessarily. There are some child welfare areas where little or no research has been done Promising practices may be implemented and studied as they are being used It makes sense to use evidence based programs when they already exist for a group of children. When an EBP does not exist, then a promising program may be used 34

Programs in Washington Multidimensional Treatment Foster Care (MTFC) Functional Family Therapy (FFT) Parent Child Interaction Therapy (PCIT) Promoting First Relationships Incredible Years Program Nurse Family Partnership Homebuilders 34

Parent Child Interaction Therapy treatment for parents and young children (ages 2-7) emphasizes improving the parent-child relationship and changing parent-child interaction patterns In PCIT, parents are taught specific skills to establish a nurturing and secure relationship with their child and methods of appropriate discipline. PCIT is provided to a parent and child pair over approximately 20 weeks. Parents are required to practice the new skills at home with their child. 34

Parent Child Interaction Therapy PRIDE Skills Praise appropriate behavior. - Use labeled praises. Reflect appropriate talk - This is the skill that gets kids to talk! Imitate appropriate play - Depending on your child, you may imitate exactly or with similarity Describe appropriate behavior. - States what the child is doing right. Enthusiasm 34

Homebuilders An Intensive Family Preservation Services program designed to prevent out of home placement of children. Utilized when a family has been referred for child abuse and neglect and the child or children are at imminent risk of placement. Program is short in duration, usually 4 to 6 weeks. (40 hours of service average in those 4 – 6 weeks) Homebuilders therapists respond to families 24 hours a day, 7 days a week. 34

Homebuilders The program focuses on teaching parents to care effectively for their children by increasing the parents ability to: manage child behavior utilize appropriate discipline, provide a safe and nurturing home environment Therapists have a low caseload (two cases at a time) 34

Functional Family Therapy Research-based prevention and intervention program for adolescents and their families Targets youth between 11-18…. Short-term, family-based program Average of 12 sessions over 4 months Range of adolescent problems drug abuse/use, conduct disorder, family conflict

FFT Family-based philosophy... We know families can be…. discouraged hopeless emotional blaming less than motivated Our job…meet them where they are… We understand all families are uniquely organized each a different and complicated social systems We know all families have strengths and resources that we can tap Family is the “client”

Guiding Principles Obtainable but lasting change The outcome goals of therapy are those that are obtainable and lasting not someone’s idea of healthy families but…….. obtainable behavioral changes ...are those that are: obtainable behavioral changes … for these people … with these resources … and these value systems … in this context (4) The outcome goals of therapy are those that are obtainable not healthy families but…….. obtainable behavioral changes (5) Therapist plays an active role in the change process focus on…. doing (pragmatic) thinking (conceptualizing) relating/(personal) active and changing role (phase dependent) relational stance 10

FFT shows several important outcomes when used in child welfare settings: a reduction in negativity within the family improved communication in the family increased parental supervision reduced placement in foster care (FPS) 11% foster placement in FFT vs. 49% foster placement in services as usual

Trauma Focused CBT treatment for children (ages 5 -18) emphasizes skills to cope with past trauma TF – CBT teaches children in an individual setting ways of coping with past traumatic experiences and new skills. Caregivers of the children participate in some sessions where they learn to support the child. This treatment is appropriate for children with “internalizing” behaviors and is not appropriate for children who are “acting out.” 34

Trauma Focused CBT Components Psycho-education Emotion regulation skills Correcting maladaptive cognitions Desensitization/trauma narrative Interpersonal skills Positive parent management 34

CBT Triangle Thoughts Behavior Feelings 34

Emotion Regulation Skills “Helping children manage negative emotions” Targets: fear, anxiety, depression, anger Strategies: Feelings identification Relaxation Controlled breathing Cognitive coping SIT Take a break Mindfulness 34

Incredible Years Program treatment for parents of young children (ages 2-7) emphasizes improving the parenting skills and use of appropriate discipline Incredible Years teaches groups of parents specific skills to use in parenting their child and methods of appropriate discipline. The Incredible Years program groups will last between 12 and 16 weeks. Parents are given homework to practice at home with their child. 34

Multidimensional Treatment Foster Care Program that serves children in a specially trained foster home Only one foster child per home Foster home is supported by a case manager that is available 24/7 Foster parents create a behavior management plan with the case manager 34

Multidimensional Treatment Foster Care The foster parents provide consistent rewards for positive behavior Privileges are gained by the child for following the program Foster child’s time heavily structured 34

Multidimensional Treatment Foster Care Child is awarded points for following rules and directions Child loses points for “problem” behavior Child usually has an individual therapist Child’s “family” has a family therapist 34

Multidimensional Treatment Foster Care Outcomes MTFC shows three important outcomes for the child welfare population: fewer placement disruptions a decrease in rate of problem behavior a 90% retention rate of foster families 34

Multisystemic Therapy (MST) treatment for families with adolescents teach parents skills and connect them to resources needed to independently address the difficulties of raising teenagers A focus is placed on helping youth and families cope with family, peer, school, and neighborhood problems. Within a context of support and skill building, the therapist places developmentally appropriate demands on the adolescent and family for responsible behavior. Intervention strategies are integrated into a social ecological context and include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavior therapies. 34

Multisystemic Therapy (MST) The program is designed as an alternative to placing children out of home. The therapist carries a caseload between 5 and 7 families and is available to the family 24/7. The interventions primary goal is to reduce the need for out of home placement. It has successfully reduced the number of days in psychiatric hospitalization by 72% as compared to a treatment as usual program. An MST adaptation for treatment of families of younger children is currently being studied for application in child welfare cases. 34

Programs being looked at: Family Integrated Transitions (FIT) Outcomes for co-occurring mental health and substance abuse Project Safe Care Home visiting program that focuses on parent and child bonding and infant/child health care 34

What about when there is no research? At times, best practices are the only thing available to guide practice When developing a new practice, evidence based programs can provide a foundation for building a program or practice (i.e. skills that are effective with a group of people) We can work with model developers and experts in the field to build the new practice or program 34

What are the limits? No one program has yet been found to solve all the problems faced by children There is not enough research on minority populations to know that every program works with every population Successful use of evidence based programs depends on having skilled providers and support from the community 34

Where to get more information The Washington State Institute for Public Policy recently published a report. http://www.wsipp.wa.gov/pub.asp?docid=08-07-3901 Other state’s are doing similar work. Information on California’s efforts can be found at: http://www.cachildwelfareclearinghouse.org                 34

Questions

For more information contact: Dana Phelps (360) 902-7653