A Framework for Effective Child Welfare Practice Series Part 4 of 5

A Framework for Effective Child Welfare Practice Series Part 4 of 5


[MUSIC PLAYING] – WELCOME TO THE FOURTH VIDEO
IN OUR FIVE-PART SERIES. – IF YOU’RE MEETING US
FOR THE FIRST TIME, WE RECOMMEND CLICKING
THE PAUSE BUTTON AND VIEWING
OUR EARLIER EPISODES. IF YOU’RE RETURNING,
WELCOME BACK. – THE FRAMEWORK TO DESIGN, TEST,
SPREAD, AND SUSTAIN EFFECTIVE CHILD WELFARE PRACTICE
INCLUDES FIVE SEQUENTIAL PHASES THAT TOGETHER FORM
A COMPLETE PROCESS FOR BUILDING EVIDENCE AND SPREADING EFFECTIVE PRACTICE
IN CHILD WELFARE. THE FRAMEWORK BEGINS
WITH IDENTIFY AND EXPLORE TO HELP US PINPOINT
AND UNDERSTAND A PROBLEM AND THEN SELECT
THE BEST SOLUTIONS BASED ON OUR THEORY OF CHANGE. AFTER COMPLETING THESE
FOUNDATIONAL STEPS, THE NEXT PHASE
OF THE FRAMEWORK DEPENDS ON THE INTERVENTION SELECTED,
ITS EVIDENCE BASE, AND WHETHER IT’S ALREADY
BEING PRACTICED IN A CHILD WELFARE AGENCY
OR SYSTEM. IF A CHILD WELFARE AGENCY HAS
PLANS TO SPREAD OR “SCALE UP” AN EVIDENCE-SUPPORTED
INTERVENTION THAT HAS SHOWN THE POTENTIAL TO EFFECTIVELY
ADDRESS A PROBLEM, THE NEXT PHASE
IS REPLICATE AND ADAPT. – LIKE IF A STATE
DECIDED THAT ALL OF ITS COMMUNITY-BASED
MENTAL HEALTH CENTERS SHOULD OFFER A PARTICULAR TYPE OF EVIDENCE-SUPPORTED
TRAUMA-FOCUSED THERAPY FOR CHILD VICTIMS OF ABUSE. – THAT’S RIGHT. IT’S IMPORTANT TO REMEMBER
THAT JUMPING AHEAD TO THIS PHASE BEFORE AN INTERVENTION
HAS BEEN RIGOROUSLY EVALUATED AND DEMONSTRATED TO WORK
DURING COMPARE AND LEARN INCREASES THE CHANCE THAT
THE UNTESTED PROGRAM OR POLICY MIGHT NOT IMPROVE
OUR INTENDED OUTCOMES. – OR WORSE, IT COULD RESULT
IN UNINTENDED OR EVEN HARMFUL EFFECTS. THE TRICK TO REPLICATING
AND SPREADING AN EVIDENCE-SUPPORTED
INTERVENTION IS THAT SOMETIMES IT ALSO NEEDS
TO BE ADAPTED OR MODIFIED TO FIT A PARTICULAR CONTEXT
OR POPULATION. THIS PROCESS CAN BE COMPLICATED. – IT CERTAINLY CAN,
AND MAKING THOSE DECISIONS OFTEN REQUIRES THE INVOLVEMENT
OF MANY DIFFERENT STAKEHOLDERS, INCLUDING THE DESIGNERS
OF THE INTERVENTION, AGENCY DECISION MAKERS
AND PROGRAM STAFF, AND MEMBERS OF THE COMMUNITY. – WHEN ATTEMPTING TO REPLICATE
OR ADAPT AN INTERVENTION, OUR GOAL IS TO ACHIEVE THE SAME
OR EVEN BETTER OUTCOMES FOR CHILDREN AND FAMILIES,
DESPITE DIFFERENCES BETWEEN THE PRACTITIONERS,
AGENCIES, AND SYSTEMS DELIVERING
THE INTERVENTION AND DESPITE ANY DIFFERENCES
BETWEEN OUR TARGET POPULATION AND THE POPULATION
WITH WHOM THE INTERVENTION WAS PREVIOUSLY PROVEN EFFECTIVE. – WE KNOW THAT TO BE EFFECTIVE, THE CORE COMPONENTS
OF AN INTERVENTION NEED TO BE DELIVERED
AS INTENDED, BUT ASPECTS OF THE PROGRAM
MAY ALSO NEED TO BE CHANGED BEFORE OUR AGENCY
CAN MAKE THE PROGRAM MORE RELEVANT
FOR PARTICULAR POPULATIONS. – YOU’RE TALKING ABOUT
MAINTAINING FIDELITY AND CONSIDERING
WHEN TO MAKE CULTURAL OR CONTEXTUAL ADAPTATIONS. – YES. LET’S TAKE THESE
ONE AT A TIME. MY AGENCY HAS BECOME
INCREASINGLY CONCERNED ABOUT YOUTH
WITH BEHAVIOR PROBLEMS. WE’VE ONLY BEGUN LOOKING FOR POSSIBLE EVIDENCE-SUPPORTED
INTERVENTIONS. SO LET’S IMAGINE THAT A COUPLE
WEEKS FROM NOW, WE DISCOVER A GROUP THERAPY
APPROACH THAT HAS BEEN RIGOROUSLY TESTED
AND REDUCES SYMPTOMS ASSOCIATED WITH TRAUMA EXPOSURE AS WELL AS AGGRESSIVE
AND HOSTILE BEHAVIORS AND LET’S SAY WE LEARN THAT
THE TEENS WHO PARTICIPATED IN THIS GROUP THERAPY PROGRAM
APPEAR VERY SIMILAR TO MANY OF THE YOUTH SERVED
BY OUR CHILD WELFARE SYSTEM. – YOU’RE SAYING THAT THESE TWO
GROUPS OF HYPOTHETICAL YOUTH SHARE IMPORTANT THINGS
IN COMMON, LIKE AGE, GENDER,
RACE AND ETHNICITY, AND MAYBE HOUSEHOLD INCOME,
FAMILY STRUCTURE, OR COMMUNITY CHARACTERISTICS. – YES, AND THEY HAVE EXPERIENCED
SIMILAR HISTORIES OF ABUSE AND CHALLENGING
BEHAVIOR PROBLEMS. OUR AGENCY MIGHT DECIDE THAT
THE GROUP THERAPY PROGRAM COULD BE AN EXCELLENT CANDIDATE
FOR REPLICATION WITH YOUTH SERVED
BY CHILD WELFARE. – SURE. THAT MAKES SENSE. – BUT WHAT IF THAT GROUP THERAPY
PROGRAM HAD ONLY BEEN DELIVERED AND TESTED IN JUVENILE
DETENTION CENTERS? – WELL, YOU MIGHT
NEED TO CONSIDER WHETHER POTENTIAL DIFFERENCES
IN DELINQUENCY AND TIME IN DETENTION
WERE IMPORTANT, BUT IF YOU STILL CHOSE
TO USE THE INTERVENTION, YOU’D PROBABLY HAVE
TO ADAPT THE PROGRAM SO THAT IT COULD BE DELIVERED
BY YOUR AGENCY. – WE’D DEFINITELY
HAVE LOTS TO CONSIDER. WE’D NEED TO FIGURE OUT WHETHER
THE GROUP THERAPY SESSIONS NEEDED TO BE ADAPTED
BEFORE OUR AGENCY OR PARTNERING SERVICE PROVIDERS
COULD DELIVER THEM AND, IF SO, HOW WOULD IT WORK
IF WE MOVED THE MODEL OUT OF A TIGHTLY CONTROLLED
SETTING WHERE YOUTH LIVE TOGETHER
TO A SETTING WHERE YOUTH ARE DISPERSED
IN DIFFERENT HOMES. WHERE WOULD THE GROUP THERAPY
SESSIONS TAKE PLACE, AND WHO WOULD LEAD THE SESSIONS? WOULD THE SESSIONS BE STRUCTURED
THE SAME WAY, OCCUR WITH THE SAME FREQUENCY,
AND BE THE SAME LENGTH OF TIME? HOW WOULD ANY PROGRAM CONTENT
NEED TO CHANGE THAT MIGHT HAVE BEEN SPECIFIC
TO ACTIVITIES AND GOAL-SETTING WHILE IN JUVENILE DETENTION, AND HOW MIGHT IMPROVED
BEHAVIOR IN DETENTION TRANSLATE TO IMPROVED BEHAVIOR
AT HOME OR AT SCHOOL? WE WOULD DEFINITELY NEED TO
COLLABORATE WITH PROGRAM EXPERTS TO PRESERVE CORE COMPONENTS
WHILE MAKING NECESSARY ADAPTATIONS
AND CAREFULLY CONSIDER HOW THESE CHANGES
MIGHT AFFECT OUTCOMES. – IT SOUNDS LIKE SOME
OF THESE POSSIBLE CHANGES WOULD ALSO TAKE INTO ACCOUNT
DIFFERENCES BETWEEN THE TARGET POPULATIONS. THAT MAKES ME THINK OF HOW
INTERVENTIONS OFTEN NEED TO BE ADAPTED
FOR DIFFERENT CULTURAL GROUPS. – ABSOLUTELY. – I’M FAMILIAR WITH SOME WORK
THAT HAS BEEN DONE RECENTLY TO ADAPT EVIDENCE-SUPPORTED
PREVENTION PROGRAMS AND MENTAL HEALTH TREATMENTS FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES. ONE PROGRAM IN PARTICULAR
REQUIRED ADAPTATION OF A PROVEN CURRICULUM
THAT PREVENTS AND TREATS BEHAVIORAL AND EMOTIONAL
PROBLEMS FOR YOUNG CHILDREN. FOR IT TO BE EFFECTIVE
FOR AMERICAN INDIAN CHILDREN AND THEIR CAREGIVERS,
THE PROGRAM’S CONTENT NEEDED TO ACKNOWLEDGE
THE HISTORY AND EXPERIENCES OF NATIVE FAMILIES
AND TO REFLECT AMERICAN INDIAN TRADITIONS,
BELIEFS, AND VALUES. WITHOUT CHANGING HOW SOME
OF THE PARENTING PRACTICES WERE TAUGHT AND UNDERSTOOD,
SOME OF THE METHODS WOULD NOT HAVE BEEN CULTURALLY
ACCEPTABLE OR EFFECTIVE. INTEGRATING MODERN PSYCHOTHERAPY
AND TRADITIONAL INDIAN CULTURE TO ADAPT AN INTERVENTION
THAT WOULD IMPROVE OUTCOMES FOR NATIVE CHILDREN AND FAMILIES
WAS A CHALLENGING PROCESS. – I CAN IMAGINE THAT WOULD BE
A DIFFICULT BALANCE TO STRIKE. – DESPITE THESE CHALLENGES,
THE CORE COMPONENTS OF THE INTERVENTION
WERE PRESERVED, AND FURTHER RIGOROUS TESTING
CONFIRMED THAT THE ADAPTED PROGRAM WAS
EFFECTIVE FOR THE NEW COMMUNITY. – WE NEED TO MENTION
JUST HOW IMPORTANT IT IS TO CAPTURE INFORMATION ABOUT
FIDELITY TO CORE COMPONENTS. WITHOUT DATA ABOUT FIDELITY,
IT’S HARD TO SAY WITH ANY CONFIDENCE
THAT WE’VE REPLICATED OR ADAPTED WHAT
HAS BEEN PROVEN TO WORK. FIDELITY DATA CAN ALSO HELP US
TO DETERMINE WHICH STRATEGIES AND FACTORS, LIKE PRACTITIONER
TRAINING AND COACHING AND ASPECTS
OF ORGANIZATIONAL CAPACITY, SUPPORT SUCCESSFUL
IMPLEMENTATION. WE WANT EFFECTIVE INTERVENTIONS
TO BE SPREAD WITH THE GREATEST
POSSIBLE IMPACT. – AND AS AN EVIDENCE-SUPPORTED
INTERVENTION IS RECEIVED BY AN INCREASING NUMBER
OF CHILDREN AND FAMILIES, FIDELITY DATA ALLOWS US
TO BETTER UNDERSTAND DIFFERENCES IN EFFECTS
FOR CERTAIN GROUPS, TOO. WE CAN EXAMINE WHETHER
DIFFERENCES IN THE EFFECTIVENESS ARE DUE TO HOW WELL
THE INTERVENTION WAS DELIVERED OR WHETHER DIFFERENCES MATTER BETWEEN GROUPS
WHO RECEIVED IT. – INFORMATION
ABOUT THESE DIFFERENCES CAN HELP OUR PRACTITIONERS
BECOME EVEN MORE SKILLED WHEN DELIVERING THE CORE
COMPONENTS OF INTERVENTIONS. AFTER ALL, THE PURPOSE
OF REPLICATE AND ADAPT IS TO INTEGRATE
EVIDENCE-SUPPORTED INTERVENTIONS WITH PRACTITIONER EXPERTISE
WHILE TAKING INTO CONSIDERATION CLIENT AND COMMUNITY
CHARACTERISTICS, CULTURE, AND PREFERENCES. – YOU’RE REMINDING ME
OF SOMETHING WE COVERED IN THE FIRST VIDEO. I REMEMBER YOU SAYING
THAT THE GOAL OF THE OVERALL FRAMEWORK IS TO
PROMOTE EVIDENCE-BASED PRACTICE. – YOU’RE EXACTLY RIGHT. EVIDENCE-BASED PRACTICE IS AT
THE HEART OF THE FRAMEWORK, AND THE REPLICATE
AND ADAPT PHASE IS ALL ABOUT PUTTING
EVIDENCE-SUPPORTED INTERVENTIONS INTO PRACTICE IN THE REAL WORLD. ONCE AN EVIDENCE-SUPPORTED
INTERVENTION HAS BEEN FULLY IMPLEMENTED
BY AN AGENCY AND HAS BECOME PART
OF ROUTINE PRACTICE, IT’S TIME TO MOVE ON
TO APPLY AND IMPROVE. – HEY, THERE’S
OUR FRIEND CHAR AGAIN. – HI, CHAR. – I HEARD THAT YOU COULD USE
A LITTLE HELP. – WE ASKED CHAR TO JOIN US
FOR DISCUSSION OF THE FINAL PHASE
IN THE FRAMEWORK, APPLY AND IMPROVE, BECAUSE SHE IS A DIRECTOR
WHOSE AGENCY IS DOING EXCITING WORK
IN THIS AREA. – BEFORE CHAR TELLS US ABOUT
THE WORK HER AGENCY HAS DONE, LET ME EXPLAIN A BIT
ABOUT THIS PHASE. DURING APPLY AND IMPROVE,
THE AGENCY HOPES TO ENHANCE ITS DECISION MAKING
AND PERFORMANCE. THIS MEANS ENSURING THAT
AN INTERVENTION CONTINUES TO BE DELIVERED AS INTENDED AND
THAT IMPROVEMENTS IN OUTCOMES ARE SUSTAINED OVER TIME. AGENCY CONTINUOUS QUALITY
IMPROVEMENT PROCESSES AND STAFF OFTEN PLAY
A CRITICAL ROLE IN THIS PHASE BECAUSE THEY MONITOR
ROUTINE PRACTICE. – THAT MAKES SENSE. CHAR, CAN YOU TELL US ABOUT YOUR AGENCY’S EXPERIENCE
WITH THIS PHASE? – SURE. IN OUR AGENCY, THE DIVISIONS
OF CHILD WELFARE SERVICES AND ALCOHOL AND DRUG SERVICES
HAVE BEEN COLLABORATING TO PROVIDE TREATMENT AND SUPPORT TO PARENTS INVOLVED
WITH THE CHILD WELFARE SYSTEM WHO SUFFER FROM
SUBSTANCE ABUSE DISORDERS. USING OUR INFORMATION SYSTEM AND LINKING DATA
FROM OUR TWO DIVISIONS, WE’VE BEEN MONITORING SERVICE
DELIVERY AND OUTCOMES. WE ALSO PERFORMED A TARGETED
REVIEW OF CHILD WELFARE CASE RECORDS
AND QUARTERLY PROGRAM REPORTS WHEN SOME OF OUR DATA
RAISED CONCERNS. THE FIRST COUPLE OF COUNTIES
TO IMPLEMENT THE EVIDENCE-SUPPORTED TREATMENT
MODEL WERE REALLY SUCCESSFUL. PARENTS STAYED CLEAN AND SOBER,
AND THEIR CHILDREN REMAINED SAFELY AT HOME WITHOUT FURTHER
REFERRALS TO OUR AGENCY. UNFORTUNATELY, OTHER OFFICES DIDN’T HAVE THE SAME LEVELS
OF SUCCESS. – WHAT DO YOU THINK ACCOUNTED
FOR THESE DIFFERENCES? – WELL, THANKFULLY, WE REQUIRED
THAT EACH PROGRAM SITE RECORD DATA ABOUT STAFF TRAINING
AND ATTENDANCE IN ITS PROGRAM REPORTS. AFTER CONDUCTING ADDITIONAL
TELEPHONE INTERVIEWS WITH LOCAL DIRECTORS AND STAFF,
WE LEARNED THAT TRAINING IN THE LOWER-PERFORMING COUNTIES
WAS NOT OFFERED OR COMPLETED AS FREQUENTLY AS IT HAD BEEN
IN THE FIRST LOCATIONS. PERHAPS DUE TO HIGHER RATES
OF STAFF TURNOVER AND FEWER AVAILABLE
TRAINING SESSIONS, CLASSES WERE FREQUENTLY
TAKEN OUT OF SEQUENCE, AND ATTENDANCE
IN SOME COUNTIES WAS POOR. WE SPECULATED THAT STAFF
WHO DIDN’T COMPLETE TRAINING AS INTENDED DIDN’T PROPERLY
IMPLEMENT THE MODEL. AS A RESULT, TREATMENT
AND OUTCOMES FOR PARENTS ACROSS THE STATE
WERE INCONSISTENT. WITH THIS IN MIND,
AGENCY LEADERSHIP USED TARGETED STRATEGIES
TO IMPROVE COMMUNICATION ABOUT THE PROGRAM. WE IMPLEMENTED ONE STATEWIDE
TRAINING PROGRAM, AND WE COLLECTED
BASIC INFORMATION ABOUT HOW CLOSELY THE SITES
FOLLOWED THE CORE COMPONENTS OF THE TREATMENT MODEL. IN OTHER WORDS,
WE TRACKED FIDELITY TO ENSURE THAT THE INTERVENTION
WAS DELIVERED CONSISTENTLY AT ALL OF THE SITES. AFTER WE MADE
THESE IMPROVEMENTS, WE CONTINUED TO MONITOR
THE RELATIONSHIP BETWEEN TRAINING COMPLETION,
PROGRAM FIDELITY, AND OUTCOMES, AND WE’RE DOING BETTER. – THAT’S A REALLY GOOD EXAMPLE
BECAUSE IT ILLUSTRATES HOW THIS PHASE FOCUSES ON CONTINUOUS
IMPROVEMENT AGENCYWIDE. YOU EXAMINED
HOW THE INTERVENTION, AS WELL AS ITS RELATED
POLICIES AND PRACTICES, WERE IMPLEMENTED
ACROSS THE ORGANIZATION BY COMPARING DATA
BETWEEN COUNTIES. THIS INCLUDED
TRAINING PRACTICES, FIDELITY ASSESSMENT,
AND OUTCOME MONITORING. YOU ALSO TOOK ACTION TO PROMOTE
WIDESPREAD UNDERSTANDING AND CONSISTENT COMMUNICATION
ABOUT THE INTERVENTION AS A PATH TOWARD
IMPROVED OUTCOMES, AND YOU’RE FOLLOWING UP TO SEE
WHETHER THEY’VE WORKED. – CHAR, WHAT WOULD HAVE HAPPENED
IF YOUR AGENCY HADN’T FOUND DIFFERENCES
IN TRAINING AND IMPLEMENTATION
BETWEEN THE COUNTIES? – I GUESS WE WOULD HAVE NEEDED
TO REVISIT THE TREATMENT MODEL AND INVESTIGATE MORE CLOSELY
WHY IT WAS WORKING FOR SOME PARENTS,
AND NOT OTHERS. WE MIGHT HAVE HAD TO CHANGE
SOMETHING ABOUT THE MODEL OR CONSIDER ALTERNATIVES. – THAT’S EXACTLY RIGHT, AND THAT MAY HAVE LED YOU TO
ANOTHER PHASE IN THE FRAMEWORK. – WE ARE OUT OF TIME, BUT JOIN
US IN THE NEXT AND FINAL VIDEO, WHERE WE’LL WALK THROUGH ALL
THE PHASES OF THE FRAMEWORK USING A SINGLE CHILD WELFARE
POLICY INTERVENTION AS AN EXAMPLE. WE’LL TIE IT ALL TOGETHER.

Daniel Yohans

Leave a Reply

Your email address will not be published. Required fields are marked *