Presentation on theme: "Building the Evidence Base for Family-Centered Practice Kristine Nelson Portland State University Todd Rofuth Southern Connecticut State University."— Presentation transcript:
Building the Evidence Base for Family-Centered Practice Kristine Nelson Portland State University Todd Rofuth Southern Connecticut State University
Evidence Based Practice for Child Welfare From the California Evidence Based Clearinghouse for Child Welfare (Wilson, nd) Modified from the Institute of Medicine Best Research Evidence Best Clinical Experience Consistent with Family Values
The Homebuilders® Model Program characteristics: Children at imminent risk of removal from the family Immediate agency response In-home intensive services (up to 20 hours a week)
The Homebuilders® Model Small caseloads (2-3 in placement prevention) Brief services (4-6 weeks) Services available around the clock Both concrete and counseling services (Kinney, Madsen, Fleming, & Haapala, 1977).
Test of an Evidence Supported Practice Is it based on an accepted conceptual/theoretical framework (is there a logic model)? Can it be replicated (manual/training)? How well is it supported by published research? Is there an acceptable level of risk?
California Clearinghouse Scientific Ratings Well supported - Effective Practice Supported - Efficacious Practice Promising Practice Acceptable/Emerging Practice Evidence Fails to Demonstrate Effect Concerning Practice
Well Supported - Efficacious Practice No evidence of substantial risk of harm Has a book/manual on how to administer service At least two rigorous randomized controlled trials in different settings Sustained effect for at least one year Overall weight of evidence supports efficacy of practice
Promising Practice No evidence of substantial risk of harm Has a book/manual on how to administer service At least one published comparison group study has established efficacy Reliable and valid outcome measures Overall weight of evidence supports efficacy of practice
Evidence Fails to Demonstrate Effect Two or more randomized controlled outcome studies have found no effect compared to usual care Overall weight of evidence in multiple studies does not support the efficacy of the practice
Evidence Regarding Risk: Maltreatment at 12 months Intervention Group Comparison Group Portland, OR ‘98 5% 9% Westat (NC, KY, TN) ‘01 nsd Michigan ‘02nsd
At Least Two Randomized Controlled Trials ProgramExper. Group Placement Control Group Placement Effect Size at 12 months Bronx ‘8927.3%25.0%-.05 New Jersey ‘91 42.7%56.7%.28 Michigan’027%27%.77
Comparison Group Studies ProgramIFPS Placement Comparison Placement Effect Size Utah ‘9144.4%85.2%.90 Portland, OR ‘98 34%51%.26 NC ‘04 Prior CAN 29%37%.17 NC ‘04 Prior Placmt 19%44%.55
Sustained Effect for 1 Year Placement at Closure Placement at 6 mths Placement at 12 mths New Jersey ‘91 7%29%46% Utah ‘913%22%33% NCarolina ‘04 13%21%27%
Overall Weight of Evidence Supports Efficacy New Jersey ‘91 - less than 25% child welfare Utah ‘91 - small case overflow study Michigan ‘02 - not published Does Not Support Efficacy Bronx ‘89 - small early study Westat ‘’01 - Implementation problems (New Jersey, Kentucky, Tennessee)
Homebuilders® = A Promising Practice Based on cognitive behavioral, social learning, and crisis theory Replicable (books/training) Supported by three published studies with comparison groups No evidence of greater risk than usual care
Other Family Preservation Models Home-based model (6 months) Based on family systems theory Caseload of 10 to 12 Family Treatment model (3 months) Counseling is primary Caseload of 10 to 12 Multi-systemic Therapy Work with family, school, and community (an evidence-based practice)
Components That Work MacLeod & Nelson’s (2000) meta- analysis of 56 programs found that programs with the following features had higher effect sizes than programs without those elements: High levels of participant involvement, An empowerment and strengths based approach, and A component of social support.
Front and Back End Goals of IFPS Front end services focusing On strengthening parenting, Improving family functioning and Enhancing child well-being Back end goal to Improve family functioning to prevent out- of-home placement or To reunify families (McCroskey, 2001).
Examples of Child and Family Outcome Measures Child Well-Being Scales Abidin Parenting Stress Index Adult-Adolescent Parenting Inventory North Carolina Family Assessment Scale
Other Outcomes Social Support Domestic Violence Family Resources Mental Health/Depression Substance Use Self-Efficacy Self-Esteem
Conclusions Clinical experience supports IFPS Consistent with family values Research-based evidence is thin
Future Directions Need to develop practice manuals and training for other models Need more studies of all types, but especially randomized clinical trials Need to add follow-up intervention to support sustained effect Need to publish studies that are out there!
Reference List Blythe, B., & Jayaratne, S. (2002). Michigan families first effectiveness study. Retrieved February 1, 2008, from http://www.michigan.gov/printerFriendly/0,1687,7-124- 5458_7695_8366-21887--,00.html http://www.michigan.gov/printerFriendly/0,1687,7-124- 5458_7695_8366-21887--,00.html The California Evidence-Based Clearinghouse for Child Welfare. (2008). Chadwick Center for Children and Families. San Diego: Rady Children's Hospital-San Diego. Retrieved on February 28, 2008 from http://www.cachildwelfareclearinghouse.org/importance- of-evidence-based-practice.http://www.cachildwelfareclearinghouse.org/importance- of-evidence-based-practice Ciliberti, P. (1998). An innovative family preservation program in an African American community: Longitudinal analysis. Family Preservation Journal, 3(2), 43-72. Feldman, L. (1991). Assessing the effectiveness of family preservation services in New Jersey within an ecological context. Trenton, NJ: New Jersey Department of Human Services, Division of Youth and Family Services.
Reference List Fraser, M., Nelson, K., & Rivard, J. (1997). Effectiveness of family preservation services. Social Work Research, 21, 138-153. Fraser, M., Pecora, P. & Haapala, D. (Eds.). (1991). Families in crisis. New York: Walter de Gruyter, Inc. Henggeler, S., Melton, G., & Smith, L. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 1-19. Retrieved June 1, 2002 from Expanded Academic Index On- line Database http://www.psycinfo.com/library/display.cfm Kinney, J., Madsen, B., Fleming, T., & Haapala, D. (1977). Homebuilders: Keeping families together. Journal of Consulting and Clinical Psychology, 45, 667-673.
Reference List Kirk, R. & Griffith, D. (2004). Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research, 28, 5-16. Mitchell, C., Tovar, P., & Knitzer, J. (1989). The Bronx Homebuilders program: An evaluation of the first 45 families. NewYork Bank Street College of Education. MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta- analytic review. Child Abuse & Neglect, 24(9), 1127–1149. McCroskey, J. (2001). What is family preservation and why does it matter? Family Preservation Journal, 5, 2, 1-24. Nelson, K., Landsman, M. & Deutelbaum, W, (1990). Three models of family-centered placement prevention services. Child Welfare, 69, 3-21.
Reference List Westat, Inc., Chapin Hall Center for Children, & James Bell Associates. (2001). Evaluation of family preservation and reunification programs: Interim report. Washington, DC: US Department of Health and Human Services. Retrieved December 18, 2007 http://aspe.hhs.gov/hsp/fampres94/index.htm http://aspe.hhs.gov/hsp/fampres94/index.htm