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Child Welfare Conference Monterey, 2008 Charles Wilson, MSSW Executive Director Laine Alexandra LCSW, Project Manager CEBC

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Presentation on theme: "Child Welfare Conference Monterey, 2008 Charles Wilson, MSSW Executive Director Laine Alexandra LCSW, Project Manager CEBC"— Presentation transcript:

1 Child Welfare Conference Monterey, 2008 Charles Wilson, MSSW Executive Director Laine Alexandra LCSW, Project Manager CEBC

2 Goals for Today’s Session Discuss the Importance of Evidence-Based Practice (EBP) and how it relates to Child Welfare. Define EBP and determine the level of empirical support that exists when selecting the best practice. Identify some of the emerging challenges with EBPs and learn some successful strategies to overcome them. Understand at least five key factors necessary for successful implementation of a new practice.

3 Lots of Terms Exist Innovative Practice Emerging Practice Promising Practice Good Practice Demonstrated Effective Practice Best Practice Empirically-Based Practice Evidence-Informed Practice Evidence-Supportive Practice Evidence-Based Practice But what do they mean?

4 Defining Evidence-Based Practice

5 Global Definition of EBP Individual clinical expertise The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The best available clinical evidence from systematic research - David Sackett, M.D. 1996 Including Both

6 CEBC’s Definition of EBP for Child Welfare (modified from Dr. David Sackett’s definition) Consistent with Family/Client Values Best Clinical Experience Best Research Evidence EBP

7 Why Is Evidence-Based Practice Important?

8 Why Evidence-Based Practice Now? A growing body of scientific knowledge allows us to take a closer look at practices. Increased understanding of the fiscal implications of not using EBP. Increased interest in outcomes and accountability by funders. Increased interest in consistent application of quality services. Past missteps in spreading untested “best practices” that turned out not to be as effective as advertised. Continuing focus on safety and effectiveness of interventions. Because they work !!

9 So how do we know what works? Let the Buyer Beware

10 Retrieved from, November 17, 2006 Roger J. Callahan, PhD Thought Field Therapy “Thought field therapy with Callahan techniques® is a powerful therapy exerted through nature's healing system to balance the body's energy system. This therapy promotes stress management and stress relief as well as the reduction or elimination of anxiety and anxiety related problems. This includes help for weight control and weight loss, trauma or sleep difficulties, depression, addictions and the disorders associated with past trauma including nightmares and post traumatic stress disorder.” (underlines added)

11 More Claims for TFT “Q. How Can TFT Benefit You? – What Kind of Problems Can Be Helped? Anxiety and Stress Personal fears or your children’s fears Anger and Frustration Eating or smoking or drinking problems Loss of loved ones Social or public speaking fears Sexual or intimacy problems Travel anxiety including fear of flying or driving on the freeways Nail biting Cravings Low moods and mood swings” Retrieved from f4cf66c40b9678b742b82989fee7b377# on November 17, 2006

12 Retrieved from October 26, 2007 Gary Craig Emotional Freedom Techniques “EFT is based on a new discovery that has provided thousands with relief from pain, diseases and emotional issues. Simply stated, it is an emotional version of acupuncture except needles aren't necessary..” “It launches off the EFT Discovery Statement which says..."The cause of all negative emotions is a disruption in the body's energy system.“ And because our physical pains and diseases are so obviously connected with our emotions the following statement has also proven to be true... "Our unresolved negative emotions are major contributors to most physical pains and diseases." “ Based on impressive new discoveries regarding the body's subtle energies, Emotional Freedom Techniques (EFT) has proven successful in thousands of clinical cases. It applies to just about every emotional, health and performance issue you can name and it often works where nothing else will. For proof, here is a sampling of our actual cases. They are written for you by everyday citizens, physicians and therapists: Pain Management, Addictions, Weight loss, Allergies, Children's Issues, Animals, Vision, Headaches, Panic/Anxiety, Asthma, Trauma, PTSD, Abuse, Depression, Dyslexia, Carpal Tunnel, Anger, ADD-ADHD, Fears/phobias, Eating disorders, OCD, Blood Pressure, Diabetes, Neuropathy, Fear of Flying, Claustrophobia, Agoraphobia, Anorexia/Bulimia, Sports and other Performance” “TFT uses similar principles as EFT but asks the student to learn 10 or 15 different tapping routines (called algorithms), each of which is designed to cover a specific issue such as trauma, phobias, depression, etc. Anything not covered by those individual routines (e.g. insomnia, TMJ, dyslexia, etc.) requires a diagnostic process. EFT, by contrast, uses only one comprehensive tapping routine to cover all issues (not just 10 or 15) and doesn't require diagnosis. ” “EFT often does the job for you cleanly and thoroughly in one or two sessions... and sometimes does it in moments. We label these latter near-instant results as "one minute wonders." Do EFT properly and you will likely experience them 50% of the time.”

13 Success Stories “PTSD (Post Traumatic Stress Disorder) responds surprisingly well to EFT. In most cases the intense feelings from those flashbacks and intrusive memories either vanish or are materially reduced within a few minutes of applying EFT. Also, repeated applications of EFT often eliminate these feelings permanently so that they no longer re- appear on a daily, weekly or monthly basis.” Testimonial from AW from Trinidad & Tobago - “I visited a therapist who did some regression with me and discovered one of my deep-seated emotional blocks occurred when I was about seven months old. Apparently I was hurt then and for whatever reasons at the time, my cries for attention went unheeded by the adults around me.” Now AW “uses EFT by tuning into herself at 7 months of age and tapping on that little girl's unhealed issues. Success!” “Dr. Patricia Carrington provides us with the story of "Claude" whose ability to catch fish rose dramatically after using EFT. ” Retrieved from October 26, 2007

14 Waiting Room Sign Ben Saunders MUSC

15 Understanding the CEBC

16 The CEBC In 2004, the California Department of Social Services, Office of Child Abuse Prevention contracted with the Chadwick Center for Children and Families, Rady Children’s Hospital-San Diego in cooperation with the Child and Adolescent Services Research Center to create the CEBC. The CEBC was launched on 6/15/06.

17 Scientific Rating Process The Scientific Rating Scale and Relevance to Child Welfare Scale

18 Scientific Rating Scale

19 Relevance to Child Welfare Scale 1. High: The program was designed or is commonly used to meet the needs of children, youth, young adults, and/or families receiving child welfare services. 2. Medium: The program was designed or is commonly used to serve children, youth, young adults, and/or families who are similar to child welfare populations (i.e. in history, demographics, or presenting problems) and likely included current and former child welfare services recipients. 3. Low: The program was designed to serve children, youth, young adults, and/or families with little apparent similarity to the child welfare services population. 1.1.

20 Parent TrainingParent Training Trauma Treatment for ChildrenTrauma Treatment for Children Reunification ServicesReunification Services Parental Substance AbuseParental Substance Abuse Youth Transitioning to AdulthoodYouth Transitioning to Adulthood Family Engagement/MotivationFamily Engagement/Motivation Topics Currently Available on the Website

21 DV Services Batterers TreatmentDV Services Batterers Treatment DV Services for Women and ChildrenDV Services for Women and Children Placement StabilizationPlacement Stabilization Supervised VisitationSupervised Visitation Prevention Prevention Topics Currently Available on the Website

22 Interventions for NeglectInterventions for Neglect Home Visiting for School ReadinessHome Visiting for School Readiness Casework PracticeCasework Practice Topics Currently Available on the Website

23 Home Visiting for the PreventionHome Visiting for the Prevention of Child Abuse and Neglect Higher Level of PlacementHigher Level of Placement Child Welfare InitiativesChild Welfare Initiatives Programs added in existing topicPrograms added in existing topicareas Next Set of Topics to be Reviewed and Rated Reviewed and Rated

24 Resource Parent Recruitment andResource Parent Recruitment andTraining Assessment/Screening ToolsAssessment/Screening Tools Post Permanency ServicesPost Permanency Services Treatment for Mental Health DisordersTreatment for Mental Health Disorders In Children and Adolescents Implementation ResourcesImplementation Resources Topic Areas and Resources Topic Areas and Resources Fiscal Year 2008/2009

25 Number of Programs per Rating Category Total Number of Programs is 85 Concerning PracticeEffective Practice 0 10 20 30 40 50 60 123456

26 Home Visiting Nurse Family Partnership Parent Training Parent-Child Interaction Therapy (PCIT) The Incredible Years Triple P Placement Stabilization Multidimensional Treatment Foster Care (MTFC) Substance Abuse (Parental) Motivational Interviewing Trauma Treatment Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Programs Rated “1” Well Supported by Research Evidence

27 Lucy! g06Q

28 Laying the Ground Work for Implementing EBPs

29 Research on Implementation Historically, there has been little research in the field of child welfare regarding the effectiveness of implementation approaches. Currently, there is an increased focus on conducting research on the implementation efforts that are underway.

30 What are some of the Challenges with Evidence-Based Practices?

31 Levels of Implementation Paper Process Performance Fixsen, D., Naoosm, S., Blasé, K., Friedman, R., Wallace, F. (2005)

32 Challenges with EBPs Agency and staff buy-in concurrent with existing workloads

33 Challenges with EBPs Cultural Issues

34 Challenges with EBPs State and local government pressure to act now- demand for action

35 Challenges with EBPs Training for providers: Costs (initial and continuing) Availability Propriety and licensing Fees

36 Challenges with EBPs Staff retention of trained personnel

37 Challenges with EBPs Buy in! (how to get it) especially among different classifications.

38 Challenges with EBPs Need for more research in child welfare

39 Challenges with EBPs It is challenging to shift culture, practice attitudes and bias.

40 Challenges with EBPs EBP may feel like the next “flavor” of the month”

41 Key Factors for the Implementation of an EBP

42 Assessment of Community Needs

43 Determine the needs of the community and choose a target problem to address Initial Community Preparation for EBP

44 Selection Preliminary Community Preparation Selection of an EBP which addresses the identified problem

45 Does the practice provide a financial or efficiency advantage to the organization and its staff as well as the clientele it serves? The higher the risk the less likely the practice will be adopted. Relative Advantage v. Risk Greenhalgh 2004

46 Match of Skill Set Does the workforce possess the appropriate clinical background and education? Greenhalgh 2004

47 Observability of Benefits Outcomes or interim results/measures The more benefits that staff can see the more likely they are to embrace the practice Clients also more likely to be engaged and motivated if they can see positive effects of their participation Greenhalgh 2004

48 Complexity For Staff: Practices that are perceived by key players as simple to use are more easily adopted Breaking the practice down into more manageable parts and adopting it incrementally Greenhalgh 2004

49 Support For Staff: Training Consultation on how to adopt and adapt practice to meet clients needs Help staff communicate information to clients about the service and its benefits (especially if transitioning them to a new service) Staff comfort level with practice will increase client’s positive experience. Greenhalgh 2004

50 Task Issues Will the practice improve the user’s performance? Will it produce superior outcomes How will it affect productivity, outcomes, rapport with clients and other important dimensions of performance? - Over Time Greenhalgh 2004

51 Engaging Clients Once staff is bought into the idea, then you have to work with clients to overcome barriers and engage them in the process…

52 Internal and External Compatibility How compatible is the practice with the organizational and workforce’s values, norms, and clinical traditions, leadership (both formal and opinion leaders) and what is the staff’s level of readiness? AND How compatible is the practice with the community, family, funder and stakeholder values, norms, and traditions? Greenhalgh 2004

53 Organizational Readiness Utilize Organizational Readiness Tools Establish an Executive Team of Powerful Stakeholders Create a Learning Organization

54 Training/Skills Learning EBP Skills Mastery Fidelity

55 Spread Sustainability Institutionalization


57 For More Information: Laine Alexandra, LCSW, Project Manager Chadwick Center- Rady Children’s Hospital-San Diego Cambria Rose, LCSW, Project Coordinator Chadwick Center- Rady Children’s Hospital-San Diego CEBC E-Mail: CEBC


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