Building the Evidence Base for Family-Centered Practice

1. Building the Evidence Base for Family-Centered Practice Kristine Nelson Portland State University Todd Rofuth Southern Connecticut State University

2. 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

3. 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)

4. 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).

5. 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?

6. California Clearinghouse Scientific Ratings • Well supported - Effective Practice • Supported - Efficacious Practice • Promising Practice • Acceptable/Emerging Practice • Evidence Fails to Demonstrate Effect • Concerning Practice

7. 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

8. 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

9. 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

10. Evidence Regarding Risk: Maltreatment at 12 months

11. At Least Two Randomized Controlled Trials

12. Comparison Group Studies

13. Sustained Effect for 1 Year

14. 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)

15. 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

16. 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)

17. 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.

18. 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).

19. Examples of Child and Family Outcome Measures • Child Well-Being Scales • Abidin Parenting Stress Index • Adult-Adolescent Parenting Inventory • North Carolina Family Assessment Scale

20. Other Outcomes • Social Support • Domestic Violence • Family Resources • Mental Health/Depression • Substance Use • Self-Efficacy • Self-Esteem

21. Conclusions • Clinical experience supports IFPS • Consistent with family values • Research-based evidence is thin

22. 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!

23. 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 • 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. • 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.

24. 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.

25. 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.

26. 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