Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment

Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.     

Effectiveness and implementation of evidence-based practices in residential care settings

Purpose

Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS?

Methods

Evidence-based psychosocial interventions and respective outcome studies, published from 1990 to 2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool.

Results

Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers.

Conclusion

The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results.     

Preparing Social Workers for Child Welfare Practice: An Innovative University–Agency Learning Collaborative

This paper describes the evolution of a university–community child welfare learning collaborative based on an adaptation of the teaching hospital concept. This partnership between an agency providing a range of child and family welfare services and two university units, the school of social work and outreach, was intended to accomplish multiple agency, university and community goals: implement best practices in the agency, enhance social work education, increase staff resources in child welfare, influence public policy, and improve the lives of children and families in the child welfare system. The major strategy was ‘Grand Rounds’ modeled after the system used to train medical students through multiple transactions with experts in a clinical setting. The first year was very successful, with students, agency staff and faculty giving the sessions high ratings in content, quality and utility. One key to the success of the initiative was that it was an agency‐driven process and was based on working relationships of mutual respect and trust. Building such relationships takes both time and effort. Future challenges will include garnering the resources, both human and financial, to sustain the collaboration over time.     

Towards Program Evaluation for Practitioner Learning: Human Service Practitioners' Perceptions of Evaluation

Abstract

While human service practice improvement is acknowledged as an important outcome of program evaluation, much evaluation is narrowly focused on accountability requirements. This type of evaluation often has limited use and relevance to human service practitioners. In exploring forms of evaluation that do have practice relevance, this article presents the experiences and perceptions of human service practitioners subject to evaluations that set out to foster learning. Across the cases participants expressed concerns about data quality and credibility, the relevance of evaluation data to the program context, the invasiveness of the evaluation, management of the process (particularly limited consultation with practitioners), and the lack of effective dissemination. These cases illustrate the challenges for evaluation to be useful to practice, and to foster meaningful improvements to services.     

Practitioner Research Capacity: A Survey of Social Workers in Northern Queensland

Abstract

Strategies to build practitioner research capacity need to be developed in order to increase the research base for social work. To be effective, strategies need to be informed by an understanding of the organisational context and the social work workforce. This paper reports the results of a cross-sectional survey of social workers conducted as part of a larger study of health practitioners in a public sector health organisation in northern Queensland. The survey demonstrates a high level of interest in research. Research methods congruent with social work's person in environment focus were favoured by participants. However, consistent with the literature, lack of confidence, limited knowledge and skills, and practical constraints impeded research activity. This study contributes to research capacity building initiatives by identifying research strengths and areas of research activity where support is required. Approaches to evidence-based practice consistent with social work and strategies for research capacity building are discussed.     

社会工作研究的人文精神——对以实证主义为导向的美国社会工作研究的批判

长期以来,国际社会工作研究常常倾向于以实证主义和经验主义为基础的研究导向,特别是在美国,"基于证据"的研究方法在社会工作领域十分流行。随着全球化的推进和人们生活方式的现代化,社会工作研究所面临的问题更为复杂,其解决方法单纯依靠各种技术处理的手段来展开是远远不够的,我们在讨论这些问题时,要强化其价值导向。这要求我们在讨论社会工作研究的问题上,把我们的关注点从证据、技术手段和职业标准扩展到价值观、人文精神和对全球化问题的关注等方面,以此来推进国际社会工作的发展。     

循证治疗联合强化抗凝对老年慢性心力衰竭的疗效分析

目的回顾性分析肝素辅助治疗老年慢性心力衰竭(CHF)的效果。方法203例确诊为CHF的住院患者分为两组:①循证标准治疗组(标准治疗组):分别或联合选用强心剂、利尿剂,ACEI类药物、β受体阻滞剂、醛固酮拮抗剂治疗;并注重病因及诱因治疗。②强化抗凝干预组(强化抗凝组):在循证标准治疗基础上,应用肝素静脉点滴或低分子肝素皮下注射治疗至少7天以上。两组间在性别、年龄、病程、平均住院天数及入院时心功能评价分布无显著性差异。结果两组总有效率分别为87.06%和94.92%:住院期间死亡率分别为12.94%和5.08%;至随访结束总死亡率分别为18.82%和6.78%(P<0.004);有非常显著性差异。结论老年CHF患者在循证标准治疗的基础上,加用肝素强化抗凝干预后,其近期疗效和远期预后明显优于标准治疗组。     

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown.Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.     

证据为本的实践的兴起及其对中国社会工作发展的启示

证据为本的实践是在西方社会工作领域兴起的关于社会工作实践立足于科学研究的结果并从众多证据中找出最佳实践的一整套基本理念和操作架构。论文介绍证据为本的实践的基本特征及其发展背景,并回顾证据为本的实践引发的主要论争,最后指出其对中国社会工作发展的启示。