efficacy to implementation in the child welfare system n.
Download
Skip this Video
Download Presentation
Efficacy to Implementation in the Child Welfare System

Loading in 2 Seconds...

play fullscreen
1 / 51

Efficacy to Implementation in the Child Welfare System - PowerPoint PPT Presentation


  • 94 Views
  • Uploaded on

Efficacy to Implementation in the Child Welfare System. J. Landsverk*, P. Chamberlain**, J. Reid** (Eve Reider***, Chair) PSMG October 26, 2005 * Child and Adolescent Services Research Center, San Diego, CA ** Oregon Social Learning Center & Center for Research to Practice, Eugene, OR

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Efficacy to Implementation in the Child Welfare System' - lyre


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
efficacy to implementation in the child welfare system
Efficacy to Implementation in the Child Welfare System

J. Landsverk*, P. Chamberlain**, J. Reid**

(Eve Reider***, Chair)

PSMG

October 26, 2005

* Child and Adolescent Services Research Center, San Diego, CA

** Oregon Social Learning Center & Center for Research to Practice, Eugene, OR

*** National Institute on Drug Abuse, Rockville, MD

slide2
Cascading Dissemination of a Foster Parent Intervention (R01 MH 60195)

Principal Investigator: Patti ChamberlainCo-Investigators: Joe Price, John Reid, John Lansverk

Funding Agency: National Institute of Mental Health

  • Preventing Health-Risking Behavior in Delinquent Girls (R01 DA15208-1)

Principal Investigator: Patti ChamberlainCo-Investigators: John Reid, Leslie Leve

Funding Agency: National Institute of Drug Abuse

  • Preventing Problems for Girls in Foster Care (R01 MH54257-6)

Principal Investigator:Patti ChamberlainCo-Investigators: Leslie Leve, John Reid

Funding Agency: National Institute of Mental Health

  • Oregon Prevention Research Center (2 P30 MH 46690)

Principal Investigator:John ReidCo-Investigators:Chamberlain, DeGarmo, Eddy, Fisher, Leve, Marinez, Fetrow, Patterson, Forgatch, Bank, Shortt, Capaldi

Funding Agency: National Institute of Mental Health

  • Pathways Home: Reducing Risk in the Child Welfare System (1 P20 DA017592)

Principal Investigator:John ReidCo-Investigators:Chamberlain, DeGarmo, Eddy, Fisher, Leve, Martinez, Fetrow, Bronz, Sprengelmeyer, and Smith

Funding Agency: National Institute of Mental Health

  • Patterns of Youth Mental Health Care in Public Service Systems (U01 MH55282)

Principal Investigator: Richard Hough

Funding Agency: National Institute of Mental Health

  • Mental Health Services Across Child Welfare Agencies (R01 MH59672)

Principal Investigator:John Lansverk

Funding Agency: National Institute of Mental Health

  • Center for Research on Child and Adolescent Mental Health Services (P50 MH50313)

Principal Investigator:John Lansverk

  • Improving Care for Children in Child Welfare (R24 MH67377)

Principal Investigator:John Lansverk

Funding Agency: National Institute of Mental Health

  • Mixed-Methods Study of a Statewide EBP Implementation (R01)

Principal Investigator:Greg Aarons

Funding Agency: National Institute of Mental Health

child welfare as a mission context
Effectiveness and implementation studies are service sector context specific (usual care), efficacy studies usually are not.

Mission of Child Welfare

Child Safety

Child Permanence

Child Well-Being

Safety & permanence services provided by CW

Well-Being services provided by other sectors (mental health, substance abuse services)

Child Welfare as a Mission Context
service sector comparison on age at entry
Service Sector Comparison on Age at Entry

= Most common entry age into service sector

context of child welfare
Context of Child Welfare
  • Yearly: 5,000,000 referred, 3,000,000 investigated (4.5% of all children), 826,000 substantiated for child abuse and neglect
  • Multiple living environments for child when services delivered: (1) home of origin, (2) out-of-home care or foster care [relative/non-relative, congregate care], (3) adoptive home
  • Service trajectories may involve movement from one child setting to another
nationally representative child welfare cohort study nscaw
Nationally Representative Child Welfare Cohort Study (NSCAW)
  • 92 primary sampling units, 6,000+ investigated cases (substantiated or indicated), followed for 36 months
  • 5 months after investigation
    • 1% in residential care (congregate) (5.7% after 36 months)
    • 10% in relative or non-relative family foster care
    • 24% received services in parent’s home
    • 65% no further services beyond investigation
need and opportunity for preventive interventions
Need and Opportunity for Preventive Interventions
  • High rates of mental disorders (42% for ages 6-17 – POC San Diego study, highest rates for ADHD, ODD, CD), developmental problems , social and cognitive problems
  • At any given time, 1% of children under 18 live in out-of-home care, estimated to be 3-7% of all children at some time
  • Externalizing problems, mission elements of safety and permanence >>> parent mediated interventions
child welfare context and effectiveness study design and measurement issues
Child Welfare Context and Effectiveness Study Design and Measurement Issues
  • Multiple child settings – multiple environmental contexts and multiple parent informants for longitudinal designs
  • Clustering at entry – multiple children removed from same family and placed in out-of-home care with confounding by maltreatment type ( more clustering for neglect)
  • Clustering for case worker functions – supervisory units of 8-10 case workers
  • Timing for identification, sampling and enrolling because of early exit bias
child welfare context and effectiveness study design issues
Child Welfare Context and Effectiveness Study Design Issues
  • Little tradition of randomized study designs and use of standardized measurement
  • Labor force: (1) case workers - BA and MSW in social work, (2) para-professional foster parent (relative & non-relative), congregate care shift workers (BA level)
  • Cost analysis complicated by multiple sector costs:
    • safety and permanence costs are paid by child welfare
    • parent training costs paid by education sector (community college)
    • ameliorative costs (mental health, substance use, developmental) paid by other service sectors
child welfare context and effectiveness study design organization of services
Child Welfare Context and Effectiveness Study Design – Organization of Services
  • Multiple levels: state and county agencies, programs within agency, supervisory units within programs, families within case worker, children within families – adjustment for clustering and nested designs
  • Child nested within foster care and within biological family
  • Service programs organized by type of child setting – importance of change of setting and it’s meaning
    • Entry into services
    • Entry into out-of-home care
    • Change of placement within out-of-home care
    • Exit from out-of-home care
    • Exit from services
collaborations among disparate research traditions
Collaborations among Disparate Research Traditions
  • Intervention Development and Efficacy Trials – relatively small n studies, “thick” measures with triangulation
  • Services Research and Clinical Epidemiology – large N studies, “thin” measures including administrative data
  • Prevention Science Methodologists
slide14

Developmental modeling and efficacy trials leading to effectiveness and Implementation trials of an intervention for foster parents in the CWS

early trials of pmt
Early trials of PMT
  • Crafted on basis of a great deal of clinical and systematic observation in homes
  • Case studies and small randomized trials.
  • Very thick measurement
replications across developmental level and sites
Replications Across Developmental Level and Sites
  • OSLC: first graders through adolescents
  • Wahler: children
  • Webster-Stratton: preschoolers
  • Eyeberg
  • Forehand
thick multi method methodology
Thick, Multi-Method Methodology
  • Naturalistic and laboratory observations
  • Parent, child, and teacher reports
  • Administrative data from schools and juvenile courts
  • Psychiatric data
  • Analogue Tasks
word slide of neglect model

e5

e6

log Abusive

e8

Index

CEES

CRSS

Congruence

Congruence

Analog

.33

e9

Physicals -

Escalation

.28**

D3

D1

2

r

r

2

.15

.30

e10

Anger

Supervision-

.70***

STAS - APT

Tracking

Punitive

Discipline

.40*

Mother

e11

e1

Inconsistent

.23

.03

Education

Discipline

.44

-.17†

Social Status

e2

-.02

.81***

HEQSS

Social

.73***

Status

Achieve-

-.05

e3

.02

HEQACH

CBCL T

e13

.36***

D4

-.11

Mother

Child

e4

Occupation

e14

Scenarios

Child

.22*

Aggression

Interviewer

Care &

e15

Rating

Environmental

r

2

.48

r

2

.12

Neglect

Age

1.00

TRF T

e17

D2

Neclect

Sex

e7

Index

Word Slide of Neglect Model

.38***

.71

-.55*

.36

.18*

.56*

log IPC

e12

Mother to

Child

.08

-.28*

.47**

.79

.30**

.41

.20*

.27*

.13

-.33*

.36**

-.15

.62

.68

.66**

.20*

CBCL T

e13b

D4b

.75

.25*

Child

.27**

e14b

Scenarios

Child

Aggression

.20*

WB

Interviewer

e15b

Rating

cmin=5356.00,df=\df,p=\p,cmindf=\cmindf,cfi=\cfi

.39**

r

2

1.29

TRF T

e17b

foster parents as agents of change
Foster Parents as Agents of Change
  • Multi-dimensional treatment Foster Care
multidimensional treatment foster care mtfc
Multidimensional Treatment Foster Care (MTFC)
  • For youth placed in out-of-home care
  • Youth are placed singly in intensively trained and supervised community foster homes that are contacted daily and supported 24/7 for 6–9 mo.
  • Interventions are implemented using multiple methods (e.g., family and individual therapy, skill training, academic supports) in key settings
  • Program supervisors carry a caseload of 10, supervise foster parents, therapists, & skills trainers, and work with parole/probation officers
  • Youth attend public schools
mtfc effects for boys
MTFC Effects for Boys
  • More time in program/fewer runaways
  • Less time in “locked” incarceration in follow-up
  • Fewer criminal offenses (½ the rate of GC boys)
  • Less likely to commit violent crimes 2 years later
  • Delinquency effects mediated by:
    • Supervision
    • Relationship with a mentoring adult
    • Consistent non-harsh discipline
    • Less association with delinquent peers

Chamberlain & Reid, 1998; Eddy & Chamberlain, 2000;

Eddy, Whaley, & Chamberlain, 2004

mtfc effects for girls
MTFC Effects for Girls
  • Delinquency
  • Deviant Peer Association
  • School Attendance & Homework Time
    • Leve, Chamberlain & Reid (in press), J of Counseling and Clinical Psychology; Leve & Chamberlain (2005) J of Abnormal Child Psychology;
    • Chamberlain & Leve, in preparation
slide29

2.7

1.5

24-month arrest outcomes

6

5

5.2

4.5

4

Mean number

of arrests

3

2

1

1.4

1.3

0.8

0.7

0

GC

MTFC

Intervention group

12 months pre-treatment entry

12 months post-treatment entry

24 months post-treatment entry

slide30

24-month locked settings outcomes

100

90

90

129

80

70

75

72

60

days in locked

Mean number of

settings

50

57

42

40

30

20

22

20

10

0

GC

MTFC

Intervention group

12 months pre-treatment

12 months post-treatment

24 months post-treatment

project keep cascading dissemination of a foster parent intervention

Project KEEPCascading Dissemination of a Foster Parent Intervention

A collaboration between the:

San Diego Health and Human Services Agency,

Child and Adolescent Services Research Center,

Oregon Social Learning Center, and

funded by the National Institute of Mental Health.

the goals of keep
The Goals of KEEP
  • To increase the parenting skills of foster and kinship parents
  • To decrease the number of placement disruptions
  • To improve child outcomes
  • To increase the number of positive placement changes (e.g. reunification, adoption)
  • To test the “cascade” question-can the intervention be implemented with equal effectiveness by a second generation of interventionists?
project keep aims to accomplish these goals by
Project KEEP aims to accomplish these goals by--
  • Promoting the idea that foster parents can serve as key agents of change for children.
  • Strengthening foster parent’s confidence and skill level so that they can successfully change their own and their child’s behaviors.
  • Helping foster parents use effective parent management strategies and provide them with support to do so
  • Increasing short and long term positive child outcomes in multiple domains and settings – home, school, with peers.
rates of child problems parent daily report pdr
Rates of child problems: Parent daily report (PDR)
  • PDR is collected by telephone from foster/kin parents
  • Each call takes 5-10 minutes
  • We collect 3 calls at baseline, another 3 calls 4 months later, and a final 3 calls 6 months after that (10 months after baseline)
  • PDR produces data on the occurrence of child behavior problems and foster parent stress
slide42

Greater than 5 problem behaviors per day at baseline predicts placement disruption within the next 6 months

After 5 behaviors, every additional behavior on the PDR increases the probability of disruption by 13 %

good news we learned that
Good news: We learned that…
  • Foster/kin parents tolerate about as much child problem behaviors as non-system families do –5 behaviors
  • PDR data is feasible to collect and is well tolerated by foster and kin parents
  • PDR data tells you who to concentrate the intervention on given limited resources : 40/60
conclusions
Conclusions
  • Preliminary data suggests KEEP group participation increase foster and kin parent skills
  • Increased parent skills translate into lower rates of child problem behaviors
  • Lower rates of child problem behaviors translate into fewer placement disruptions & more frequent placement transitions to family/relative care
review of design and methods issues raised
Review of Design and Methods Issues Raised
  • Use of Administrative Data to measure outcomes (CWS vs. Juvenile Court / School Records)
  • Measurement of proximal or targeted processes (Parent Reports and PDR)
  • Moving from Thick to Thin Assessment
  • Power when large community units are unit of randomization
  • How do we team up efficiently with PSMG