for Child Welfare

1. The California Evidence-Based Clearinghouse for Child Welfare (CEBC) www.cachildwelfareclearinghouse.org 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 The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Including Both The best available clinical evidence from systematic research Individual clinical expertise -David Sackett, M.D. 1996

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

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. 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) Roger J. Callahan, PhD Retrieved from http://www.tftrx.com/, November 17, 2006

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 http://www.tftrx.com/profaq.php?PHPSESSID= f4cf66c40b9678b742b82989fee7b377# on November 17, 2006

12. Emotional Freedom Techniques “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. ” “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” “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." “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.” Gary Craig Retrieved from http://www.emofree.com/ October 26, 2007

13. Success Stories “Dr. Patricia Carrington provides us with the story of "Claude" whose ability to catch fish rose dramatically after using EFT.” 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!” “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.” Retrieved from http://www.emofree.com/ 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. • 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. • Low: • The program was designed to serve children, youth, young adults, and/or families with little apparent similarity to the child welfare services population.

20. Topics Currently Available on the Website • Parent Training • Trauma Treatment for Children • Reunification Services • Parental Substance Abuse • Youth Transitioning to Adulthood • Family Engagement/Motivation

21. Topics Currently Available on the Website • DV Services Batterers Treatment • DV Services for Women and Children • Placement Stabilization • Supervised Visitation • Prevention

22. Topics Currently Available on the Website • Interventions for Neglect • Home Visiting for School Readiness • Casework Practice

23. Home Visiting for the Prevention • of Child Abuse and Neglect • Higher Level of Placement • Child Welfare Initiatives • Programs added in existing topic • areas Next Set of Topics to be Reviewed and Rated

24. Topic Areas and Resources Fiscal Year 2008/2009 • Resource Parent Recruitment and • Training • Assessment/Screening Tools • Post Permanency Services • Treatment for Mental Health Disorders • In Children and Adolescents • Implementation Resources

25. Number of Programs per Rating CategoryTotal Number of Programs is 85 60 50 40 30 20 10 0 1 2 3 4 5 6 Effective Practice Concerning Practice

26. Programs Rated “1” Well Supported by Research Evidence 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)

27. Lucy! http://www.youtube.com/watch?v=4wp3m1vg06Q

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) http://nirn.fmhi.usf.edu

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. Assessment of Community Needs • 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. Organizational Readiness • Utilize Organizational Readiness Tools • Establish an Executive Team of Powerful Stakeholders • Create a Learning Organization

46. Training/Skills • Learning EBP Skills • Mastery • Fidelity

47. Spread • Sustainability • Institutionalization

49. 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:cebclearinghouse@rchsd.org CEBC Website:www.cachildwelfareclearinghouse.org