Evidence Based Practice
Child Welfare System
Webcast Training
September 15, 2005
Presented by
California Institute for Mental Health
Main Points
Defining evidence-based practices
Child welfare outcomes
Child welfare specific practices
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Evidence-Based Practices
“…the integration of the best research
evidence with clinical expertise and
patient values”
 Based on the definition used in “Crossing the
Quality Chasm: A New Health System for the
21st Century” (2001), by the Institute of
Medicine
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Levels of Science
 Effective--achieves outcomes, controlled
research (random assignment), with independent
replication in usual care settings.
 Efficacious--achieves outcomes, controlled
research (random assignment), independent
replication in controlled settings.
 Not effective--significant evidence of a null,
negative, or harmful effect.
 Promising--some positive research evidence,
quasi-experimental, of success and/or expert
consensus.
 Emerging practice--recognizable as a distinct
practice with “face” validity or common sense test.
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Child Welfare Outcomes
 Protection from abuse and neglect
 Children maintained safely at home
 Families have enhanced capacity to provide
for children’s needs
 Permanency and stability without increasing
foster care re-entry
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Child Welfare Evidence-Based
Practices
 Multidimensional treatment foster care
 Early intervention foster care
 Incredible years
 Triple P parenting
 Nurse family partnership
 Parent-child interaction therapy
 Functional family therapy
 Trauma-Focused Cognitive Behavioral
Therapy
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Multidimentional Treatment Foster
Care (MTFC)
 Effective
 Teenage youth in or at-risk group home
 Increases foster parent competencies
 Decreases in child behavioral problems
 Increases in parenting competencies
 Low rate of re-entry into foster care or the
juvenile justice system
 Patti Chamberlain and colleagues from Oregon
Social Learning Center
 www.mtfc.com
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MTFC
 Interdisciplinary team
 One child per foster home
 Intensive foster parent training
 Foster parent support group and daily calls
 Behavior point system in the foster home
 Individual therapy for the youth
 Behavior skills training for the youth
 Family therapy for biological family
 Coordination with school, family and others
 24 support to foster parent and biological family
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Early Intervention Foster Care
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Promising--efficacious
Preschool age foster children
Increases foster parent competencies
Strong support for foster parents
Decrease in child behavior problems
Develops age appropriate child competencies
Improves parenting competencies
Decreases parental stress and depression
Increase in social support
Promotes reunification
Phil Fisher and colleagues from Oregon Social
Learning Center
 Pfisher@oslc.org Evidence Based Practices
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Early Intervention Foster Care
 Interdisciplinary team
 Intensive foster parent training
 Foster parent support groups
 Daily support calls
 24 support to foster parent and biological family
 Child focused therapy
 Behavioral specialist for child in preschool,
childcare or home settings
 Parent training
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The Incredible Years
 Effective
 Children 2-12
 Decreases child behavior problems
 Increases parenting competencies
 Decreases maternal stress
 Strengthens parent-teacher and parentcaregiver relationships
 Carolyn Webster-Stratton, University of
Washington
 www.incredibleyears.org
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Incredible Years
 Facilitated group intervention, practitioners with diverse
educational backgrounds
 Three sets of comprehensive developmentally based
curriculums for parents, teachers and children to
promote emotional and social competence
 Basic parenting (early and school age)
 Advanced parenting
 Supporting your child’s education
 Child social skills
 Classroom based
 Teacher training
 Weekly groups (12-14 sessions), 2 hours in length
 Uses work books, and video-vignettes to illustrate skills
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Triple P Parenting
 Effective
 Children 0-16
 Improves parenting skills
 Decrease in parental stress and depression
 Improves coping skills
 Decrease in child behavior problems
 Improves partner support
 Improves parent anger management skills
 Decreases social isolation
 Matt Sanders, University of Queensland
 www1.triplep.net
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Triple P Parenting
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Practitioners with diverse educational backgrounds
Parenting program
Titrated levels of intervention
Detailed support material for parents
Five levels of intervention from primary prevention to
treatment
Universal Triple P (primary prevention)
Selected Triple P
Primary Care Triple P
Standard Triple P (individual or group)
Enhanced Triple P
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Nurse Family Partnership
 Effective
 Low-income, high risk first time parents
(pregnancy-age 2)
 Intensive home visitation to promote health and
welfare of parents and children
 Improved pregnancy outcomes
 Improved child health and well being
 Increases economic self-sufficiency
 David Olds and his colleagues, University of
Colorado
 www.nursefamilypartnership.org
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Nurse Family Partnership
Registered nurse
Intensive home visitation
Mother’s personal health
Quality of care
Life course outcomes
Visitations begin no later than 28 weeks of
gestation until age 2
Visits involve mother’s support system
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Parent-Child Interaction Therapy
 Effective
 Children ages 2-8 years
 Parent-child guided intervention
 Decrease child behavior problems
 Increases parenting competencies
 Sheila Eyberg and colleagues, University of
Florida
 www.pcit.org
 http://www.ucdmc.ucdavis.edu/caare/mental/pcit
_traincenter.html
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Parent-Child Interaction Therapy
Therapists
Clinic with two-way mirror, and “bug in the
ear” technology
Individual sessions (about 12)
Home models being developed
Parent-child guided intervention
Relationship
Discipline
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Functional Family Therapy
 Effective
 Youth ages 11-18 years
 Decreases family negativity and hostility
 Decreases child behavior problems
 Decreases the need for out of home placement
 Increases parenting competencies
 Jim Alexander and colleagues, University of
Utah
 www.fftinc.com
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Functional Family Therapy
Practitioners with diverse educational
backgrounds
Individual family sessions (about 12-14)
Standard process with content tailored to
individual families
Multiple phases
Engagement
Change behavior
Generalization
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Trauma-Focused Cognitive
Behavioral Therapy
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Effective
Children ages 4-18 years
Decreases PTSD symptoms
Decreases negative attributes (self-blame) about the
traumatic event
Decreases externalizing problem behaviors
Improves parent-child relationship
Decreases parental depression
Improves parenting
Judith Cohen and Anthony Mannarino, Allegheny
General Hospital
Jcohen1@wpahs.org or Amannari@wpahs.org
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Trauma-Focused Cognitive
Behavioral Therapy
 Therapists (LPHA)
 Individual sessions (weekly) with the child,
parent and joint child-parent (12-16 sessions)
Therapeutic relationship
Psycho-education
Emotional regulation
Stress management
Connecting thoughts, feelings and behaviors
Gradual in vivo exposure
Cognitive and affective processing of trauma
experiences
Personal safety and skills training
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