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

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

3. 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”

4. 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

5. 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

6. The problem(S) Pervasive self-stimulating behavior (“the trance”)
Identified since age 2
No disclosed experience/exposure to sexual abuse
Estimated 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.”

7. 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: 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

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

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

10. 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

11. Step 2: Search the literature

14. 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)

17. 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)

18. Step 5: Evaluate client outcomes

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

21. Comments? Questions?

22. READY?!?

23. 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

24. 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.

25. 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,